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NPI Code Detail

MEDICARE: EASTERN PODIATRY PLLC

MEDICARE: EASTERN PODIATRY PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213E00000XPodiatrist

General Provider Information

NPI Number : 1366942526
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASTERN PODIATRY PLLC
Provider Business Mailing Address
First Line : 2802 AVENUE P
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-1810
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 601 E POLK ST
Second Line :
City : WASHINGTON
State : IA
Zip : 52353-1238
Country : US
Telephone Number : 718-972-5000
Fax Number : 718-972-3774
Authorized Official
Title or Position : SOLE PROPRIETOR
Name : ALAN R TAJERSTEIN
Credential :
Telephone Number : 718-972-5000
Provider Enumeration Date : 02/14/2018
Last Update Date : 02/14/2018

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Directions to “EASTERN PODIATRY PLLC ” Practice Location

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