Provider Demographics
NPI:1699052662
Name:WALK RIGHT
Entity type:Organization
Organization Name:WALK RIGHT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:BASIL
Authorized Official - Last Name:FARID
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:718-948-6353
Mailing Address - Street 1:300 SHIRLEY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-5455
Mailing Address - Country:US
Mailing Address - Phone:718-948-6353
Mailing Address - Fax:718-948-6257
Practice Address - Street 1:300 SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5455
Practice Address - Country:US
Practice Address - Phone:718-948-6353
Practice Address - Fax:718-948-6257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01549480Medicaid
NY0846320001Medicare UPIN