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General NPI Number Information
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NPI Number | 1033328844
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Entity Type | Organization
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Legal Business Name | GREATER QUEENS PODIATRY
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 03/28/2008
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Provider Practice Location Address
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Address Line | 4343 KISSENA BLVD #110
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City | FLUSHING
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State | NY
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Zip | 11355-2914
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Country | US
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Telephone | 718-463-1515
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Fax | 718-886-6414
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Provider Business Mailing Address
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Address Line | 4343 KISSENA BLVD #110
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City | FLUSHING
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State | NY
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Zip | 11355-2914
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Country | US
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Telephone | 718-463-1515
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Fax | 718-886-6414
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Authorized Official
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Title or Position | PHYSICIAN
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Name | NICHOLAS MEGDANIS
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Credential | M.D.
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Telephone | 718-463-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N004326
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License Number State | NY
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