MEDICARE: SUFFOLK 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

General Provider Information

NPI Number	:	1790882983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUFFOLK PODIATRY PC

Provider Business Mailing Address
First Line	:	111 CARLETON AVE
Second Line	:	SUITE 5
City	:	ISLIP TERRACE
State	:	NY
Zip	:	11752-2236
Country	:	US
Telephone Number	:	631-581-8822
Fax Number	:	631-581-0857

Provider Business Practice Location Address
First Line	:	111 CARLETON AVE
Second Line	:	SUITE 5
City	:	ISLIP TERRACE
State	:	NY
Zip	:	11752-2236
Country	:	US
Telephone Number	:	631-581-8822
Fax Number	:	631-581-0857

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PETER CUTLER
Credential	:	D.P.M.
Telephone Number	:	631-581-8822

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	05/04/2010

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