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General NPI Number Information
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NPI Number | 1043517758
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Entity Type | Organization
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Legal Business Name | EASTERN PODIATRY LLC
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Dates
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Enumeration Date | 02/15/2011
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Last Update Date | 02/15/2011
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Provider Practice Location Address
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Address Line | 231 S WASHINGTON ST
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City | MILLSBORO
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State | DE
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Zip | 19966-1236
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Country | US
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Telephone | 718-972-5000
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Fax | 718-972-3774
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Provider Business Mailing Address
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Address Line | 1335 54TH ST
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City | BROOKLYN
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State | NY
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Zip | 11219-4220
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Country | US
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Telephone | 718-972-5000
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Fax | 718-972-3774
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALAN TAJERSTEIN
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Credential |
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Telephone | 718-972-5000
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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 |
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License Number State |
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