Healthcare Provider Details

I. General information

NPI: 1427354505
Provider Name (Legal Business Name): WESTSIDE PODIATRIC ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W CENTURY RD SUITE 240
PARAMUS NJ
07652-1433
US

IV. Provider business mailing address

85 STELLING AVE
MAYWOOD NJ
07607-2135
US

V. Phone/Fax

Practice location:
  • Phone: 201-491-2173
  • Fax: 201-586-0202
Mailing address:
  • Phone: 201-491-2173
  • Fax: 201-586-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2517
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. DAVID P LUONGO
Title or Position: OWNER
Credential: DPM
Phone: 201-491-2173