Healthcare Provider Details

I. General information

NPI: 1669757571
Provider Name (Legal Business Name): UNIVERSITY FOOT AND ANKLE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CRANE ROAD
LLOYD HARBOUR NY
11743-6691
US

IV. Provider business mailing address

5 CRANE RD
LLOYD HARBOR NY
11743-1732
US

V. Phone/Fax

Practice location:
  • Phone: 914-649-4700
  • Fax:
Mailing address:
  • Phone: 914-649-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number005788
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License NumberN005788
License Number StateNY

VIII. Authorized Official

Name: DR. DAVID M. BARTOL
Title or Position: OWNER
Credential: DPM
Phone: 914-649-4700