Healthcare Provider Details

I. General information

NPI: 1538554571
Provider Name (Legal Business Name): MICHAEL J SKONIECZNY DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WATERS PL SUITE M101
BRONX NY
10461-2728
US

IV. Provider business mailing address

237 COLUMBUS AVE APT 2A
PORT CHESTER NY
10573-2534
US

V. Phone/Fax

Practice location:
  • Phone: 718-863-0244
  • Fax: 718-863-0246
Mailing address:
  • Phone: 914-474-4638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number006630-1
License Number StateNY

VIII. Authorized Official

Name: MICHAEL SKONIECZNY
Title or Position: OWNER
Credential: DPM
Phone: 914-474-4638