Provider Demographics
NPI:1932595519
Name:ERB PODIATRY, P.C.
Entity Type:Organization
Organization Name:ERB PODIATRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:ELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-830-3239
Mailing Address - Street 1:2417 JERICHO TPKE
Mailing Address - Street 2:#355
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4710
Mailing Address - Country:US
Mailing Address - Phone:719-830-3239
Mailing Address - Fax:718-830-3839
Practice Address - Street 1:9876 QUEENS BLVD
Practice Address - Street 2:SUITE 1C
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4398
Practice Address - Country:US
Practice Address - Phone:718-830-3239
Practice Address - Fax:718-830-3839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005731213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7551120001Medicare NSC