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General NPI Number Information
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NPI Number | 1972900264
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Entity Type | Organization
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Legal Business Name | 89TH STREET PODIATRY PC
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Dates
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Enumeration Date | 12/02/2014
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 1588 3RD AVE
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City | NEW YORK
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State | NY
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Zip | 10128-3401
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Country | US
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Telephone | 212-410-9666
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Fax | 212-348-1736
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Provider Business Mailing Address
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Address Line | 1588 3RD AVE
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City | NEW YORK
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State | NY
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Zip | 10128-3401
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Country | US
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Telephone | 212-410-9666
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Fax | 212-348-1736
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DEAN SPELLMAN
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Credential | D.P.M.
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Telephone | 212-410-9666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | AAAASF CERT # 3876
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License Number State | NY
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