=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407933732
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PODIATRIC HEALTHCARE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 05/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 WARREN CT
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01970-3163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-744-1309
-----------------------------------------------------
Fax | 978-744-3783
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 WARREN CT
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01970-3163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-744-1309
-----------------------------------------------------
Fax | 978-744-3783
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GREGORY MARC VAN ESS
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 978-744-1309
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 2119
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------