Healthcare Provider Details

I. General information

NPI: 1285887422
Provider Name (Legal Business Name): DYKER PARK FOOTCARE, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8404 13TH AVE
BROOKLYN NY
11228-3302
US

IV. Provider business mailing address

8404 13TH AVE
BROOKLYN NY
11228-3302
US

V. Phone/Fax

Practice location:
  • Phone: 718-745-6220
  • Fax: 718-745-6229
Mailing address:
  • Phone: 718-745-6220
  • Fax: 718-745-6229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN006056
License Number StateNY

VIII. Authorized Official

Name: DR. PASQUALE MICHAEL DESANTO
Title or Position: PODIATRIST
Credential: DPM
Phone: 718-745-6220