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General NPI Number Information
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NPI Number | 1356510283
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Entity Type | Organization
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Legal Business Name | NORTH COUNTRY PODIATRY,PC
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 626 CANAL RD
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City | MOUNT SINAI
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State | NY
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Zip | 11766-3309
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Country | US
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Telephone | 631-331-3338
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Fax | 631-331-0014
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Provider Business Mailing Address
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Address Line | 626 CANAL RD
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City | MOUNT SINAI
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State | NY
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Zip | 11766-3309
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Country | US
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Telephone | 631-331-3338
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Fax | 631-331-0014
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Authorized Official
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Title or Position | OWNER/PRINCIPAL
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Name | DR. MARK G. GRESSER
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Credential | D.P.M.
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Telephone | 631-331-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | N003743
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License Number State | NY
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