Provider Demographics
NPI:1295911014
Name:DYKER HEIGHTS FOOT & ANKLE
Entity type:Organization
Organization Name:DYKER HEIGHTS FOOT & ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:MEGDANIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-921-2156
Mailing Address - Street 1:8407 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3401
Mailing Address - Country:US
Mailing Address - Phone:718-921-2156
Mailing Address - Fax:718-921-9536
Practice Address - Street 1:8407 15TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3401
Practice Address - Country:US
Practice Address - Phone:718-921-2156
Practice Address - Fax:718-921-9536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003445213ES0103X
NYN004898213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4265250001Medicare NSC