=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679384176
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEAVIEW PODIATRY P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2025
-----------------------------------------------------
Last Update Date | 05/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2143 S BRANCH RD
-----------------------------------------------------
City | BRANCHBURG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08876-3929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-720-6866
-----------------------------------------------------
Fax | 718-720-6931
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 970 BARD AVE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10301-3322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-720-6866
-----------------------------------------------------
Fax | 718-720-6931
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MINA BASKHRON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-658-2526
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP1100X
-----------------------------------------------------
Taxonomy Name | Podiatric Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------