Provider Demographics
NPI:1356392500
Name:EAST COAST PODIATRIC MEDICINE AND SURGERY LLC
Entity type:Organization
Organization Name:EAST COAST PODIATRIC MEDICINE AND SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAJERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-370-6672
Mailing Address - Street 1:2802 AVENUE P
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1810
Mailing Address - Country:US
Mailing Address - Phone:917-370-6672
Mailing Address - Fax:718-252-5810
Practice Address - Street 1:5401 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2573
Practice Address - Country:US
Practice Address - Phone:917-370-6672
Practice Address - Fax:718-252-5810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6902261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9874Medicare PIN