NPIMap

Organization Active NPI

Eastern Podiatry PLLC

  • Podiatrist
  • Lynnwood, WA
National Provider Identifier
1104692219
Registry record updated Nov 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
EASTERN PODIATRY PLLC
Practice address
3701 188TH St SW
Lynnwood, WA 98037-7626
Phone
(718) 972-5000
NPI assigned
Nov 29, 2023
Last updated
Nov 29, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Alan R TajersteinNPI 1891782587
Title
Owner
Phone
(718) 972-5000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X NU Primary

Addresses

Primary practice location

3701 188TH St SW
Lynnwood, WA 98037-7626

Mailing address

2802 Avenue P
Brooklyn, NY 11229-1810
Phone (718) 972-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240223001267 WA Part B Supplier - Clinic/Group Practice 1951448711 Receives reassigned benefits from 2 practitioners
Practice locations: Gig Harbor, WA

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Eastern Podiatry PLLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

220 W Post Rd
White Plains, NY 10606
Phone (914) 686-8880

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701216000000",
    "number": "1104692219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2802 AVENUE P",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112291810",
            "telephone_number": "718-972-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 188TH ST SW",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980377626",
            "telephone_number": "718-972-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN PODIATRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-29",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "status": "A",
        "authorized_official_last_name": "TAJERSTEIN",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-972-5000"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynnwood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.