Provider Demographics
NPI:1255786331
Name:PARK PLACE PODIATRY PLLC
Entity type:Organization
Organization Name:PARK PLACE PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LILKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-779-3654
Mailing Address - Street 1:291 BROADWAY STE 810
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-1814
Mailing Address - Country:US
Mailing Address - Phone:212-484-0922
Mailing Address - Fax:
Practice Address - Street 1:291 BROADWAY STE 810
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007
Practice Address - Country:US
Practice Address - Phone:212-484-0922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006450213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG300101471Medicare PIN