Provider Demographics
NPI:1396911525
Name:GREATER QUEENS PODIATRY PLLC
Entity type:Organization
Organization Name:GREATER QUEENS PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MEGDANIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-229-0222
Mailing Address - Street 1:PO BOX 610406
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-0406
Mailing Address - Country:US
Mailing Address - Phone:718-229-0222
Mailing Address - Fax:718-717-0275
Practice Address - Street 1:4401 FRANCIS LEWIS BLVD
Practice Address - Street 2:L3-B
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3002
Practice Address - Country:US
Practice Address - Phone:718-229-0222
Practice Address - Fax:718-717-0275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01049958Medicaid
NY6194960001Medicare NSC
NYG100000020Medicare PIN
NYT32074Medicare UPIN