Organization Active NPI

Linda Podiatry PC

  • Podiatrist
  • New York, NY
National Provider Identifier
1356623771
Registry record updated Sep 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
N006252 Issued in NY
Legal business name
LINDA PODIATRY PC
Practice address
700 W 192ND St
Apt# 606
New York, NY 10040-2402
Phone
(917) 399-0361
NPI assigned
Sep 12, 2011
Last updated
Sep 12, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2011

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

Authorized official

Name
Dr. Eka Davitachvili, DPMNPI 1376797894
Title
Incorporator/Director/DPM
Phone
(917) 399-0361

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X N006252 NY Primary

Addresses

Primary practice location

700 W 192ND St
Apt# 606
New York, NY 10040-2402

Mailing address

700 W 192 Street
Apt# 606
New York, NY 10040
Phone (917) 399-0361

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111103000287 NY Part B Supplier - Clinic/Group Practice 3577736735 Receives reassigned benefits from 1 practitioner
Practice locations: Brooklyn, NY; Roslyn Heights, NY; New York, NY; Jamaica, NY; Forest Hills, NY

National Provider Directory

National Provider Directory

Locations

1068 48th St
Brooklyn, NY 11219
Phone (718) 269-5151

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1315785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315785600000",
    "number": "1356623771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 W 192 STREET",
            "address_2": "APT# 606",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10040",
            "telephone_number": "917-399-0361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W 192ND ST",
            "address_2": "APT# 606",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100402402",
            "telephone_number": "917-399-0361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINDA PODIATRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-12",
        "last_updated": "2011-09-12",
        "status": "A",
        "authorized_official_last_name": "DAVITACHVILI",
        "authorized_official_first_name": "EKA",
        "authorized_official_title_or_position": "INCORPORATOR/DIRECTOR/DPM",
        "authorized_official_telephone_number": "917-399-0361",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NY",
            "license": "N006252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2011; 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.