Provider Demographics
NPI:1982808499
Name:JACKSON HEIGHTS OBS PLLC
Entity Type:Organization
Organization Name:JACKSON HEIGHTS OBS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ANARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-779-3900
Mailing Address - Street 1:3741 91ST ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7927
Mailing Address - Country:US
Mailing Address - Phone:718-779-3900
Mailing Address - Fax:
Practice Address - Street 1:3741 91ST ST
Practice Address - Street 2:
Practice Address - City:JACKSON HTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7927
Practice Address - Country:US
Practice Address - Phone:718-779-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004054213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT51386Medicare UPIN