MEDICARE: DR. DANIEL KORMYLO DPM

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	213E00000X	Podiatrist	N004250	NY
2	213E00000X	Podiatrist	004250	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	480008364	OTHER		MEDICARE RAILROAD
3	1049990002	OTHER	NY	MEDICARE DME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699776674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL KORMYLO DPM

Provider Business Mailing Address
First Line	:	PO BOX 5153
Second Line	:
City	:	ROCKY POINT
State	:	NY
Zip	:	11778-0969
Country	:	US
Telephone Number	:	631-744-8282
Fax Number	:	631-821-5583

Provider Business Practice Location Address
First Line	:	745 RT 25A
Second Line	:	SUITE B
City	:	ROCKY POINT
State	:	NY
Zip	:	11778-0969
Country	:	US
Telephone Number	:	631-744-8282
Fax Number	:	631-821-5583

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	04/03/2024

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Directions to “ DR. DANIEL KORMYLO DPM” Practice Location

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