Provider Demographics
NPI:1457426595
Name:FOOTDRX, LLP
Entity Type:Organization
Organization Name:FOOTDRX, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HERSTIK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:888-265-0610
Mailing Address - Street 1:44 E 12TH ST APT MD4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4667
Mailing Address - Country:US
Mailing Address - Phone:212-366-1718
Mailing Address - Fax:212-366-4830
Practice Address - Street 1:44 E 12TH ST APT MD4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4667
Practice Address - Country:US
Practice Address - Phone:212-366-1718
Practice Address - Fax:212-366-4830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4295950001Medicare NSC
NYPHW081Medicare PIN