Healthcare Provider Details

I. General information

NPI: 1306018783
Provider Name (Legal Business Name): NORTH SHORE PODIATRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 PLANDOME RD DOOR 2
MANHASSET NY
11003
US

IV. Provider business mailing address

535 PLANDOME RD DOOR 2
MANHASSET NY
11003
US

V. Phone/Fax

Practice location:
  • Phone: 516-365-5544
  • Fax: 516-365-5545
Mailing address:
  • Phone: 516-365-5544
  • Fax: 516-365-5545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN005323
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01774249
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: DR. LAUREN A SCHWARTZ
Title or Position: OWNER
Credential: DPM
Phone: 516-365-5544