Provider Demographics
NPI:1831628007
Name:ALPS ROAD FAMILY FOOT AND ANKLE
Entity type:Organization
Organization Name:ALPS ROAD FAMILY FOOT AND ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:G
Authorized Official - Last Name:GODOY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-650-5270
Mailing Address - Street 1:1855 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3940
Mailing Address - Country:US
Mailing Address - Phone:973-650-5270
Mailing Address - Fax:973-832-4062
Practice Address - Street 1:2323 EASTCHESTER RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5910
Practice Address - Country:US
Practice Address - Phone:973-650-5270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006293-1261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric