Provider Demographics
NPI:1386716926
Name:MOUNT ZION PODIATRY PC
Entity type:Organization
Organization Name:MOUNT ZION PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:OWUSU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM,MA
Authorized Official - Phone:718-385-2085
Mailing Address - Street 1:106 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-2427
Mailing Address - Country:US
Mailing Address - Phone:718-385-2085
Mailing Address - Fax:
Practice Address - Street 1:106 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-2427
Practice Address - Country:US
Practice Address - Phone:718-385-2085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005044174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY014305142Medicaid
NY014305142Medicaid
NYP59541Medicare ID - Type Unspecified