Provider Demographics
NPI:1891975041
Name:REMINGTON PODIATRY GROUP
Entity Type:Organization
Organization Name:REMINGTON PODIATRY GROUP
Other - Org Name:RICHARD T. KOENIGSBERG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIEM
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-735-8592
Mailing Address - Street 1:697 E REMINGTON DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1941
Mailing Address - Country:US
Mailing Address - Phone:408-735-8592
Mailing Address - Fax:408-735-0930
Practice Address - Street 1:697 E REMINGTON DR
Practice Address - Street 2:SUITE A
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1941
Practice Address - Country:US
Practice Address - Phone:408-735-8592
Practice Address - Fax:408-735-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1641213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT11018Medicare UPIN