Healthcare Provider Details

I. General information

NPI: 1467736603
Provider Name (Legal Business Name): MICHAEL J. SKONIECZNY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MICHAEL J SKONIECZNY DPM

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
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:
Mailing address:
  • Phone: 508-747-1973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberLPR00101
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number006630
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2448
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: