Healthcare Provider Details

I. General information

NPI: 1427272772
Provider Name (Legal Business Name): 6P PODIATRY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENUE P MEDICAL OFFICE 209 AVENUE P
BROOKLYN NY
11204
US

IV. Provider business mailing address

AVENUE P MEDICAL CENTER 209 AVENUE P
BROOKLYN NY
11204
US

V. Phone/Fax

Practice location:
  • Phone: 718-259-6666
  • Fax: 718-259-7000
Mailing address:
  • Phone: 718-259-6666
  • Fax: 718-259-7000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number005980
License Number StateNY

VIII. Authorized Official

Name: GRIGORIY PATISH
Title or Position: PRESIDENT
Credential: DPM
Phone: 718-259-6666