Basic Information
| Provider Information | |||||||||
| NPI: | 1740691682 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEAPORT PODIATRY GROUP PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7902 BAY PKWY | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112141965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182367520 | ||||||||
| FaxNumber: | 7182364250 | ||||||||
| Practice Location | |||||||||
| Address1: | 7902 BAY PKWY | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112141965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182367520 | ||||||||
| FaxNumber: | 7182364250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2014 | ||||||||
| LastUpdateDate: | 05/14/2014 | ||||||||
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| AuthorizedOfficialLastName: | SHERMAN | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
| AuthorizedOfficialMiddleName: | JAY | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7182367520 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.P.M. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 002396 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.