Provider Demographics
NPI:1356623771
Name:LINDA PODIATRY PC
Entity type:Organization
Organization Name:LINDA PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR/DIRECTOR/DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:EKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVITACHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:917-399-0361
Mailing Address - Street 1:700 W 192 STREET
Mailing Address - Street 2:APT# 606
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040
Mailing Address - Country:US
Mailing Address - Phone:917-399-0361
Mailing Address - Fax:
Practice Address - Street 1:700 W 192ND ST
Practice Address - Street 2:APT# 606
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-2402
Practice Address - Country:US
Practice Address - Phone:917-399-0361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006252213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty