Healthcare Provider Details

I. General information

NPI: 1457683104
Provider Name (Legal Business Name): ALL COUNTY FOOT AND ANKLE LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28-56 A 41ST STREET 2FL
ASTORIA NY
11103-3301
US

IV. Provider business mailing address

PO BOX 236
OLD WESTBURY NY
11568-0236
US

V. Phone/Fax

Practice location:
  • Phone: 718-728-3334
  • Fax: 718-777-3180
Mailing address:
  • Phone: 718-728-3334
  • Fax: 718-777-3180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. GIANNI PERSICH
Title or Position: GENERAL PARTNER
Credential: DPM
Phone: 718-728-3334