Provider Demographics
NPI:1821333063
Name:PHASE TWO PODIATRY PC
Entity Type:Organization
Organization Name:PHASE TWO PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NACHUM
Authorized Official - Middle Name:
Authorized Official - Last Name:PELCOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-792-0070
Mailing Address - Street 1:301 MILL ROAD
Mailing Address - Street 2:SUITE U-7
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-2326
Mailing Address - Country:US
Mailing Address - Phone:516-792-0070
Mailing Address - Fax:516-706-6607
Practice Address - Street 1:301 MILL ROAD
Practice Address - Street 2:SUITE U-7
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-2326
Practice Address - Country:US
Practice Address - Phone:516-792-0070
Practice Address - Fax:516-706-6607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005974213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty