MEDICARE: GREAT STRIDES PODIATRY, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	N006236	NY

General Provider Information

NPI Number	:	1558784280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT STRIDES PODIATRY, P.C.

Provider Business Mailing Address
First Line	:	7111 110TH ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4851
Country	:	US
Telephone Number	:	718-520-8811
Fax Number	:	718-520-6646

Provider Business Practice Location Address
First Line	:	7111 110TH ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4851
Country	:	US
Telephone Number	:	718-520-8811
Fax Number	:	718-520-6646

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LEKEISHA Y GEORGE
Credential	:	DPM
Telephone Number	:	917-593-4771

Provider Enumeration Date	:	01/31/2014
Last Update Date	:	06/10/2014

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