MEDICARE: EASTERN PODIATRY PLLC

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	213E00000X	Podiatrist	004639	NY

General Provider Information

NPI Number	:	1821227299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN PODIATRY PLLC

Provider Business Mailing Address
First Line	:	1468 E 10TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6504
Country	:	US
Telephone Number	:	718-972-5000
Fax Number	:	718-972-3774

Provider Business Practice Location Address
First Line	:	1468 E 10TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6504
Country	:	US
Telephone Number	:	718-972-5000
Fax Number	:	718-972-3774

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALAN TAJERSTEIN
Credential	:	D.P.M.
Telephone Number	:	718-972-5000

Provider Enumeration Date	:	07/07/2009
Last Update Date	:	11/24/2020

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