Provider Demographics
NPI:1669628020
Name:HARBOR PODIATRY,PC
Entity type:Organization
Organization Name:HARBOR PODIATRY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCSHANE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-593-2233
Mailing Address - Street 1:131 MAIN ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1739
Mailing Address - Country:US
Mailing Address - Phone:516-593-2233
Mailing Address - Fax:516-593-0897
Practice Address - Street 1:131 MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-1739
Practice Address - Country:US
Practice Address - Phone:516-593-2233
Practice Address - Fax:516-593-0897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003954332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT51280Medicare UPIN
NY1189180001Medicare NSC