SOUTHSIDE PODIATRY PC NPI 1205968799

NPI Information

NPI: 1205968799
Provider Name: SOUTHSIDE PODIATRY PC
Classification: Podiatrist - 213E00000X
Entity Type: Organization
Address:
903 E 82ND ST
BROOKLYN, NY
ZIP 11236
Phone: (718) 241-2000
Get Directions

SOUTHSIDE PODIATRY PC is a podiatrist in Brooklyn, NY. The provider is a podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. SOUTHSIDE PODIATRY PC NPI is 1205968799. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

903 E 82ND ST
BROOKLYN, NY
ZIP 11236
Phone: (718) 241-2000
Fax: (718) 241-5281

The provider's authorized official is Mark Elliott Hupart .
The authorized official title is Dpm/president and has the following contact phone number (718) 241-2000.

The enumeration date for this NPI number is 3/10/2007 and was last updated on 7/19/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	213E00000X	Podiatrist		N002003-1	NEW YORK	No
2	213E00000X	Podiatrist		N004686	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	=========	OTHER	NEW YORK	UNITED HEALTH CARE
2	=========	OTHER	NEW YORK	BLUE CROSS
3	=========	OTHER	NEW YORK	AMEICHOICE
4	=========	OTHER	NEW YORK	GHI
5	=========	OTHER	NEW YORK	EVERCARE
6	01180363	MEDICAID	NEW YORK
7	=========	OTHER	NEW YORK	EMPIRE PLAN
8	=========	OTHER	NEW YORK	1199
9	P5W621	MEDICARE PIN	NEW YORK
10	=========	OTHER	NEW YORK	AETNA
11	=========	OTHER	NEW YORK	APWU
12	P5W62	MEDICARE ID-TYPE UNSPECIFIED	NEW YORK
13	=========	OTHER	NEW YORK	AARP
14	=========	OTHER	NEW YORK	CIGNA
15	=========	OTHER	NEW YORK	HEALTHNET
16	=========	OTHER	NEW YORK	BLUE SHEILD
17	U18041	MEDICARE UPIN	NEW YORK
18	01522036	MEDICAID	NEW YORK
19	=========	OTHER	NEW YORK	HIP

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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