Provider Demographics
NPI:1194563007
Name:JG PODIATRY SHEEPSHEAD
Entity type:Organization
Organization Name:JG PODIATRY SHEEPSHEAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRZESIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-693-6578
Mailing Address - Street 1:527 LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-3262
Mailing Address - Country:US
Mailing Address - Phone:347-693-6578
Mailing Address - Fax:
Practice Address - Street 1:2409 AVENUE Z
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2631
Practice Address - Country:US
Practice Address - Phone:718-934-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty