Healthcare Provider Details

I. General information

NPI: 1437985074
Provider Name (Legal Business Name): PLYMOUTH PODIATRY BIDCO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 COURT ST STE 3
PLYMOUTH MA
02360-8710
US

IV. Provider business mailing address

116 COURT ST STE 3
PLYMOUTH MA
02360-8710
US

V. Phone/Fax

Practice location:
  • Phone: 508-747-1973
  • Fax: 508-747-5392
Mailing address:
  • Phone: 508-747-1973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SKONIECZNY
Title or Position: PARTNER
Credential: DPM
Phone: 508-747-1973