Madison Podiatry LLC

Primary specialty

PodiatristTaxonomy code 213E00000X

License

25MD00322600 Issued in NJ

Legal business name

MADISON PODIATRY LLC

Practice address

52 Skyline Dr
Ringwood, NJ 07456-2020

Phone

(973) 962-7775

NPI assigned

May 25, 2017

Last updated

May 25, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Daniel Pollack, DPMNPI 1548515315

Title

Owner

Phone

(917) 873-6483

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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.

• Daniel Pollack, DPM

  • Primary Podiatric Medicine Podiatrist
  • Brooklyn, NY
  • NPI 1548515315
  Authorized official Same address or phone

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

{
    "created_epoch": "1495670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1495670400000",
    "number": "1548798234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "971 WILSON AVE",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076661863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 SKYLINE DR",
            "city": "RINGWOOD",
            "state": "NJ",
            "postal_code": "074562020",
            "telephone_number": "973-962-7775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON PODIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-25",
        "last_updated": "2017-05-25",
        "status": "A",
        "authorized_official_last_name": "POLLACK",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-873-6483",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NJ",
            "license": "25MD00322600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "G300078632",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Marie Lorah-Lidestri, LPC
• Lotus98 LLC
• Radu Myron Lupsa, DDS
• Sheri Lyski, LPC
• Jean Mackenzie, MS
• Avni Mahmudi, DIPL OM
• Kathleen Mavourneen MC Carty, RN, APN
• Annmarie McDonough
• MD Place Urgent Care, P.C.
• Medhat Raouf, M.D., P.a.

• Podiatrist in Ringwood, NJ
• Providers in Ringwood, NJ by specialty
• Podiatrist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.