Provider Demographics
NPI:1548700636
Name:ESSENTIAL PODIATRY PC
Entity type:Organization
Organization Name:ESSENTIAL PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOOJI
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-642-8851
Mailing Address - Street 1:23 SARATOGA ST
Mailing Address - Street 2:
Mailing Address - City:TAPPAN
Mailing Address - State:NY
Mailing Address - Zip Code:10983-2620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23 SARATOGA ST
Practice Address - Street 2:
Practice Address - City:TAPPAN
Practice Address - State:NY
Practice Address - Zip Code:10983-2620
Practice Address - Country:US
Practice Address - Phone:845-642-8851
Practice Address - Fax:914-328-2467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty