Provider Demographics
NPI:1386878049
Name:KEITH A MOBILIA,DPM.PC
Entity type:Organization
Organization Name:KEITH A MOBILIA,DPM.PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOBILIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-979-1333
Mailing Address - Street 1:2338 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2346
Mailing Address - Country:US
Mailing Address - Phone:718-979-1333
Mailing Address - Fax:718-351-3215
Practice Address - Street 1:2338 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2346
Practice Address - Country:US
Practice Address - Phone:718-979-1333
Practice Address - Fax:718-351-3215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0038671213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6266110001Medicare NSC