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General NPI Number Information
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NPI Number | 1689925166
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Entity Type | Organization
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Legal Business Name | EASTSIDE PODIATRY ASSOCIATES, PC
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Dates
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Enumeration Date | 09/25/2012
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Last Update Date | 05/08/2013
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Provider Practice Location Address
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Address Line | 210 EAST 68TH STREET SUITE 1F
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City | NEW YORK
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State | NY
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Zip | 10065-6024
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Country | US
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Telephone | 212-472-8872
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Fax | 212-472-8873
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Provider Business Mailing Address
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Address Line | 210 EAST 68TH STREET SUITE 1F
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City | NEW YORK
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State | NY
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Zip | 10065-6024
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Country | US
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Telephone | 212-472-8872
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Fax | 212-472-8873
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MRS. AFSANEH LATIFI
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Credential | DPM
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Telephone | 212-472-8872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | N3866
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | N5286
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | N005286
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License Number State | NY
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