Provider Demographics
NPI:1922337849
Name:STARRETT PODIATRY, LLC
Entity Type:Organization
Organization Name:STARRETT PODIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-642-2088
Mailing Address - Street 1:1390 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-2103
Mailing Address - Country:US
Mailing Address - Phone:718-642-2088
Mailing Address - Fax:718-642-2096
Practice Address - Street 1:1390 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-2103
Practice Address - Country:US
Practice Address - Phone:718-642-2088
Practice Address - Fax:718-642-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005753261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric