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NPI Code Detail

MEDICARE: SEAPORT PODIATRY OBS, P.C.

MEDICARE: SEAPORT PODIATRY OBS, P.C.
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
1213ES0103XFoot & Ankle Surgery PodiatristN3866NY

General Provider Information

NPI Number : 1558541268
Entity Type Code : Organization
Provider Name (Legal Business Name) : SEAPORT PODIATRY OBS, P.C.
Provider Business Mailing Address
First Line : 111 JOHN ST
Second Line : SUITE 1450
City : NEW YORK
State : NY
Zip : 10038-3101
Country : US
Telephone Number : 212-791-5700
Fax Number :
Provider Business Practice Location Address
First Line : 111 JOHN ST
Second Line : SUITE 1450
City : NEW YORK
State : NY
Zip : 10038-3101
Country : US
Telephone Number : 212-791-5700
Fax Number :
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. JAMES MILIDANTRI
Credential : DPM
Telephone Number : 212-791-5700
Provider Enumeration Date : 11/09/2007
Last Update Date : 11/09/2007

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