Healthcare Provider Details

I. General information

NPI: 1760261754
Provider Name (Legal Business Name): GRAND CENTRAL PODIATRIC CARE AND SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 E 47TH ST FL 2
NEW YORK NY
10017-1919
US

IV. Provider business mailing address

1360 WHITTIER AVE
MERRICK NY
11566-1739
US

V. Phone/Fax

Practice location:
  • Phone: 855-863-3668
  • Fax:
Mailing address:
  • Phone: 516-969-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SUNNY MAKHIJANI
Title or Position: DOCTOR
Credential:
Phone: 516-554-5220