Provider Demographics
NPI:1366545501
Name:GREAT NECK PODIATRY ASSOCIATES
Entity type:Organization
Organization Name:GREAT NECK PODIATRY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GREIFF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-829-1028
Mailing Address - Street 1:29 BARSTOW RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2209
Mailing Address - Country:US
Mailing Address - Phone:516-829-1028
Mailing Address - Fax:516-829-3530
Practice Address - Street 1:29 BARSTOW RD
Practice Address - Street 2:SUITE 101
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2209
Practice Address - Country:US
Practice Address - Phone:516-829-1028
Practice Address - Fax:516-829-3530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN4806213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01630666Medicaid
NY01630666Medicaid
P54351Medicare ID - Type Unspecified