Provider Demographics
NPI:1427272772
Name:6P PODIATRY P.C.
Entity type:Organization
Organization Name:6P PODIATRY P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRIGORIY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATISH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-259-6666
Mailing Address - Street 1:AVENUE P MEDICAL CENTER
Mailing Address - Street 2:209 AVENUE P
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204
Mailing Address - Country:US
Mailing Address - Phone:718-259-6666
Mailing Address - Fax:718-259-7000
Practice Address - Street 1:AVENUE P MEDICAL OFFICE
Practice Address - Street 2:209 AVENUE P
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204
Practice Address - Country:US
Practice Address - Phone:718-259-6666
Practice Address - Fax:718-259-7000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005980213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty