Provider Demographics
NPI:1255930079
Name:ATLANTIC PODIATRY PLLC
Entity type:Organization
Organization Name:ATLANTIC PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:646-918-4393
Mailing Address - Street 1:489 ATLANTIC AVE # 1A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2985
Mailing Address - Country:US
Mailing Address - Phone:718-489-1130
Mailing Address - Fax:718-489-1127
Practice Address - Street 1:489 ATLANTIC AVE # 1A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2985
Practice Address - Country:US
Practice Address - Phone:718-489-1130
Practice Address - Fax:718-489-1127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty