Healthcare Provider Details

I. General information

NPI: 1245888981
Provider Name (Legal Business Name): NORTH ISLAND PODIATRY ASSOCIATES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

596 PENNSYLVANIA AVE
BROOKLYN NY
11207-6308
US

IV. Provider business mailing address

1543 E 96TH ST
BROOKLYN NY
11236-5303
US

V. Phone/Fax

Practice location:
  • Phone: 347-442-5847
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA LETTMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 347-551-3816