Provider Demographics
NPI:1023299096
Name:ADVANCED PODIATRY OF HUNTINGTON PLLC
Entity type:Organization
Organization Name:ADVANCED PODIATRY OF HUNTINGTON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:HENDIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-427-3678
Mailing Address - Street 1:76 E MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2837
Mailing Address - Country:US
Mailing Address - Phone:631-427-3678
Mailing Address - Fax:631-427-5595
Practice Address - Street 1:76 E MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2837
Practice Address - Country:US
Practice Address - Phone:631-427-3678
Practice Address - Fax:631-427-5595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005950-1332B00000X
213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6061220001Medicare NSC