Provider Demographics
NPI:1770609497
Name:PODIATRY ASSOCIATES OF NEW MEXICO LTD
Entity type:Organization
Organization Name:PODIATRY ASSOCIATES OF NEW MEXICO LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:KERBLESKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:505-797-1001
Mailing Address - Street 1:8300 CARMEL AVE NE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-3147
Mailing Address - Country:US
Mailing Address - Phone:505-797-1001
Mailing Address - Fax:
Practice Address - Street 1:711 ENCINO PL NE
Practice Address - Street 2:SUITE G
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2619
Practice Address - Country:US
Practice Address - Phone:505-243-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM79012Medicaid
NMCH3682OtherMEDICARE RAILROAD
NMCH3682OtherMEDICARE RAILROAD
NM0736600001Medicare NSC