Healthcare Provider Details

I. General information

NPI: 1295911014
Provider Name (Legal Business Name): DYKER HEIGHTS FOOT & ANKLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8407 15TH AVE
BROOKLYN NY
11228-3401
US

IV. Provider business mailing address

8407 15TH AVE
BROOKLYN NY
11228-3401
US

V. Phone/Fax

Practice location:
  • Phone: 718-921-2156
  • Fax: 718-921-9536
Mailing address:
  • Phone: 718-921-2156
  • Fax: 718-921-9536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN003445
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN004898
License Number StateNY

VIII. Authorized Official

Name: DR. ERNEST MEGDANIS
Title or Position: MEMBER
Credential: DPM
Phone: 718-921-2156