Provider Demographics
NPI:1942691761
Name:FLUSHING PODIATRY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:FLUSHING PODIATRY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:KWONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-539-9001
Mailing Address - Street 1:3712 PRINCE ST STE 3D
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4650
Mailing Address - Country:US
Mailing Address - Phone:718-539-9001
Mailing Address - Fax:718-539-9173
Practice Address - Street 1:3712 PRINCE ST STE 3D
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4650
Practice Address - Country:US
Practice Address - Phone:718-539-9001
Practice Address - Fax:718-539-9173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2023-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01912849Medicaid