Healthcare Provider Details

I. General information

NPI: 1801629845
Provider Name (Legal Business Name): LV PODIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6134 188TH ST STE 203
FRESH MEADOWS NY
11365-2726
US

IV. Provider business mailing address

6134 188TH ST STE 203
FRESH MEADOWS NY
11365-2726
US

V. Phone/Fax

Practice location:
  • Phone: 718-454-4333
  • Fax: 718-454-4823
Mailing address:
  • Phone: 718-454-4333
  • Fax: 718-454-4823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. QUYNH LEE
Title or Position: MEMBER
Credential: DPM
Phone: 718-454-4333