MEDICARE: TWIN COUNTY PODIATRY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0131X	Foot Surgery Podiatrist	N006079	NY
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1609943117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWIN COUNTY PODIATRY PC

Provider Business Mailing Address
First Line	:	33 N OCEAN AVE STE 4
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-3049
Country	:	US
Telephone Number	:	516-378-0184
Fax Number	:	516-378-0294

Provider Business Practice Location Address
First Line	:	33 N OCEAN AVE STE 4
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-3049
Country	:	US
Telephone Number	:	516-378-0184
Fax Number	:	516-378-0294

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SCOTT EVAN HERBERT
Credential	:	DPM
Telephone Number	:	516-378-0184

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	08/05/2011

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