Healthcare Provider Details

I. General information

NPI: 1114790870
Provider Name (Legal Business Name): LYNBROOK PODIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 ATLANTIC AVE
LYNBROOK NY
11563-3567
US

IV. Provider business mailing address

215 ATLANTIC AVE
LYNBROOK NY
11563-3567
US

V. Phone/Fax

Practice location:
  • Phone: 516-599-5688
  • Fax: 516-599-5029
Mailing address:
  • Phone: 516-599-5688
  • Fax: 516-599-5029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. EUGENE KIM
Title or Position: OWNER
Credential: DPM
Phone: 516-599-5688