Provider Demographics
NPI:1700697414
Name:NORTHEAST PODIATRY CONSULTANT PLLC
Entity type:Organization
Organization Name:NORTHEAST PODIATRY CONSULTANT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:347-771-8637
Mailing Address - Street 1:608 PRESCOTT PL
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3034
Mailing Address - Country:US
Mailing Address - Phone:347-771-8637
Mailing Address - Fax:347-238-3601
Practice Address - Street 1:3103 AVENUE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5412
Practice Address - Country:US
Practice Address - Phone:347-771-8637
Practice Address - Fax:347-238-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty