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General NPI Number Information
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NPI Number | 1912596271
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Entity Type | Organization
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Legal Business Name | 5 BORO PODIATRY PC
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Dates
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Enumeration Date | 01/12/2021
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Last Update Date | 01/12/2021
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Provider Practice Location Address
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Address Line | 531 TARGEE ST
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City | STATEN ISLAND
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State | NY
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Zip | 10304-3501
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Country | US
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Telephone | 646-837-5448
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Fax | 718-775-3150
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Provider Business Mailing Address
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Address Line | 1578 WILLIAMSBRIDGE RD APT 3A
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City | BRONX
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State | NY
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Zip | 10461-6268
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SADIA SHAH
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Credential |
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Telephone | 917-613-1629
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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 |
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License Number State |
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