Provider Demographics
NPI:1942340948
Name:STATEN ISLAND PODIATRY, P.C.
Entity Type:Organization
Organization Name:STATEN ISLAND PODIATRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSHEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BATHLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-826-5709
Mailing Address - Street 1:364 EDISON ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-3041
Mailing Address - Country:US
Mailing Address - Phone:718-524-4112
Mailing Address - Fax:718-524-4189
Practice Address - Street 1:364 EDISON ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3041
Practice Address - Country:US
Practice Address - Phone:718-524-4112
Practice Address - Fax:718-524-4189
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATEN ISLAND PODIATRY, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-07
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherEIN
NY6287710001Medicare NSC