Healthcare Provider Details

I. General information

NPI: 1083894265
Provider Name (Legal Business Name): ALL COUNTY PODIATRY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4207 30TH AVE
ASTORIA NY
11103-2910
US

IV. Provider business mailing address

PO BOX 422
OLD WESTBURY NY
11568-0422
US

V. Phone/Fax

Practice location:
  • Phone: 718-261-5999
  • Fax:
Mailing address:
  • Phone: 718-261-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number004789
License Number StateNY

VIII. Authorized Official

Name: DR. GIANNI PERSICH
Title or Position: PRESIDENT
Credential: DPM
Phone: 718-261-5999