Provider Demographics
NPI:1700104296
Name:NORTH SHORE FOOT & ANKLE, LLC
Entity type:Organization
Organization Name:NORTH SHORE FOOT & ANKLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIOT
Authorized Official - Middle Name:G
Authorized Official - Last Name:SHERR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:978-531-4484
Mailing Address - Street 1:205 ANDOVER ST
Mailing Address - Street 2:ROUTE 114
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1603
Mailing Address - Country:US
Mailing Address - Phone:978-531-4484
Mailing Address - Fax:866-214-2666
Practice Address - Street 1:205 ANDOVER STREET
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1603
Practice Address - Country:US
Practice Address - Phone:978-531-4484
Practice Address - Fax:866-214-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1497213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6710960001Medicare NSC
MAT11304Medicare UPIN