Healthcare Provider Details

I. General information

NPI: 1184629826
Provider Name (Legal Business Name): JACQUELINE MURPHY D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 NASSAU BLVD S
GARDEN CITY NY
11530-5539
US

IV. Provider business mailing address

11 NASSAU BLVD S
GARDEN CITY NY
11530-5539
US

V. Phone/Fax

Practice location:
  • Phone: 516-292-8222
  • Fax:
Mailing address:
  • Phone: 516-292-8222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN004784
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: