Provider Demographics
NPI:1306116900
Name:WESTSIDE PODIATRIC ASSOCIATES LLC
Entity type:Organization
Organization Name:WESTSIDE PODIATRIC ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:LUONGO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-491-2173
Mailing Address - Street 1:85 STELLING AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-2135
Mailing Address - Country:US
Mailing Address - Phone:201-491-2173
Mailing Address - Fax:201-586-0202
Practice Address - Street 1:10 MCKINLEY ST STE 15
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-2726
Practice Address - Country:US
Practice Address - Phone:201-784-1900
Practice Address - Fax:201-784-8785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005487-1213ES0131X
NJMD00251700213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty