Healthcare Provider Details

I. General information

NPI: 1497771604
Provider Name (Legal Business Name): BILL W DALOSIS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 POND PATH
LAKE GROVE NY
11755-1831
US

IV. Provider business mailing address

97 POND PATH
LAKE GROVE NY
11755-1831
US

V. Phone/Fax

Practice location:
  • Phone: 786-457-4723
  • Fax:
Mailing address:
  • Phone: 786-457-4723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number006161
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: