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General NPI Number Information
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NPI Number | 1356623771
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Entity Type | Organization
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Legal Business Name | LINDA PODIATRY PC
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Dates
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Enumeration Date | 09/12/2011
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 700 W 192ND ST APT# 606
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City | NEW YORK
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State | NY
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Zip | 10040-2402
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Country | US
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Telephone | 917-399-0361
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Fax |
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Provider Business Mailing Address
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Address Line | 700 W 192 STREET APT# 606
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City | NEW YORK
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State | NY
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Zip | 10040
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Country | US
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Telephone | 917-399-0361
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Fax |
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Authorized Official
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Title or Position | INCORPORATOR/DIRECTOR/DPM
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Name | DR. EKA DAVITACHVILI
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Credential | DPM
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Telephone | 917-399-0361
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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 | N006252
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License Number State | NY
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