Provider Demographics
NPI:1972900264
Name:89TH STREET PODIATRY PC
Entity Type:Organization
Organization Name:89TH STREET PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:212-410-9666
Mailing Address - Street 1:1588 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3401
Mailing Address - Country:US
Mailing Address - Phone:212-410-9666
Mailing Address - Fax:212-348-1736
Practice Address - Street 1:1588 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3401
Practice Address - Country:US
Practice Address - Phone:212-410-9666
Practice Address - Fax:212-348-1736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAAAASF CERT # 3876261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCERT# 3876OtherAMERICAN ASSOCIATION FOR ACCCREDITATION OF AMBULATORY SURGERY FACILITIIES, INC.