Provider Demographics
NPI:1972762458
Name:TRI-STATE FOOT CARE, P.C
Entity type:Organization
Organization Name:TRI-STATE FOOT CARE, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VASILIOS
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:SPYROPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-464-1065
Mailing Address - Street 1:13 S SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-3433
Mailing Address - Country:US
Mailing Address - Phone:866-464-1065
Mailing Address - Fax:
Practice Address - Street 1:1164 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5418
Practice Address - Country:US
Practice Address - Phone:866-464-1065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005668213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP07851OtherMEDICARE ID NUMBER
NY02180183Medicaid
NYU81194Medicare UPIN
NYP07851OtherMEDICARE ID NUMBER