Provider Demographics
NPI:1871822213
Name:QUALITY PODIATRY GROUP OF FL LTD
Entity Type:Organization
Organization Name:QUALITY PODIATRY GROUP OF FL LTD
Other - Org Name:QUALITY PODIATRY GROUP OF FLORIDA CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:786-975-2090
Mailing Address - Street 1:7025 BERACASA WAY
Mailing Address - Street 2:UNIT #102-G
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3443
Mailing Address - Country:US
Mailing Address - Phone:786-975-2090
Mailing Address - Fax:847-674-2113
Practice Address - Street 1:7025 BERACASA WAY
Practice Address - Street 2:UNIT #102-G
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3428
Practice Address - Country:US
Practice Address - Phone:786-975-2090
Practice Address - Fax:847-674-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8620213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty