Provider Demographics
NPI:1891994091
Name:NORTH SHORE PODIATRIC MEDICINE & SURGERY, P.C.
Entity Type:Organization
Organization Name:NORTH SHORE PODIATRIC MEDICINE & SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-326-4709
Mailing Address - Street 1:410 LAKEVILLE RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1101
Mailing Address - Country:US
Mailing Address - Phone:516-326-4709
Mailing Address - Fax:516-326-8968
Practice Address - Street 1:410 LAKEVILLE RD
Practice Address - Street 2:SUITE 303
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1101
Practice Address - Country:US
Practice Address - Phone:516-326-4709
Practice Address - Fax:516-326-8968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5022770001Medicare NSC