Provider Demographics
NPI:1902112774
Name:PODIATRY ASSSOCIATES INC
Entity Type:Organization
Organization Name:PODIATRY ASSSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-935-6566
Mailing Address - Street 1:601 N FLAMINGO RD
Mailing Address - Street 2:STE 104
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1007
Mailing Address - Country:US
Mailing Address - Phone:305-935-6566
Mailing Address - Fax:800-430-6126
Practice Address - Street 1:21097 NE 27TH CT STE 370
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1234
Practice Address - Country:US
Practice Address - Phone:305-935-6566
Practice Address - Fax:888-521-3029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1378213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty