Provider Demographics
NPI:1053404798
Name:EASTERN PODIATRY PA
Entity type:Organization
Organization Name:EASTERN PODIATRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:LESCOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:252-757-1600
Mailing Address - Street 1:2100 HEMBY LANE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3996
Mailing Address - Country:US
Mailing Address - Phone:252-757-1600
Mailing Address - Fax:
Practice Address - Street 1:2100 HEMBY LANE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3996
Practice Address - Country:US
Practice Address - Phone:252-757-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC186213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012RAMedicaid
NC4377820001Medicare NSC
NC2432614Medicare PIN