Healthcare Provider Details

I. General information

NPI: 1376159756
Provider Name (Legal Business Name): WEST SIDE FOOT GROUP, L.L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 W 54TH ST FL 10
NEW YORK NY
10019-5597
US

IV. Provider business mailing address

244 W 54TH ST FL 10
NEW YORK NY
10019-5597
US

V. Phone/Fax

Practice location:
  • Phone: 212-768-8666
  • Fax:
Mailing address:
  • Phone: 212-768-8666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGG GREENBLATT
Title or Position: PARTNER
Credential: DPM
Phone: 917-543-1243