Active NPI
Eugene D Podolsky, DPM
- Podiatrist
- Niles, OH
National Provider Identifier
1043217896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 3600-2212
- Practice address
- 720 Youngstown Warren Rd
Niles, OH 44446-3551 - Phone
- (330) 652-0535
- Fax
- (330) 652-0536
- NPI assigned
- Jul 7, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 3600-2212 | OH | Primary |
Addresses
Primary practice location
720 Youngstown Warren Rd
Niles, OH 44446-3551
Mailing address
PO Box 378
Sandusky, OH 44871-0378
Phone (419) 626-6161
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2104005-000 | Medicaid | WV | |
| 4080718 | Medicaid | OH | |
| 0628593 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3600-2212 | OH | MD | Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550707200000",
"number": "1043217896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 378",
"city": "SANDUSKY",
"state": "OH",
"postal_code": "448710378",
"telephone_number": "419-626-6161",
"fax_number": "419-502-3511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "720 YOUNGSTOWN WARREN RD",
"city": "NILES",
"state": "OH",
"postal_code": "444463551",
"telephone_number": "330-652-0535",
"fax_number": "330-652-0536"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PODOLSKY",
"first_name": "EUGENE",
"middle_name": "D",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-07",
"last_updated": "2019-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "OH",
"license": "3600-2212",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2104005-000",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4080718",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0628593",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Niles, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.