Organization
SOUTHSIDE PODIATRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK ELLIOTT HUPART (DPM/PRESIDENT)
(718) 241-2000
Entity
Organization
Contact information
Practice address
903 E 82ND ST, BROOKLYN, NY 11236
(718) 241-2000
(718) 241-5281
Mailing address
903 E 82ND ST, BROOKLYN, NY 11236-3811
(718) 241-2000
(718) 241-5281
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
N002003-1
NY
213E00000X
Podiatrist
Primary
N004686
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01180363
—
NY
05
—
01522036
—
NY
Enumeration date
03/10/2007
Last updated
07/19/2010
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