Healthcare Provider Details

I. General information

NPI: 1275653776
Provider Name (Legal Business Name): MASSAPEQUA PODIATRY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 MERRICK RD SUITE 1
MASSAPEQUA NY
11758-6000
US

IV. Provider business mailing address

4160 MERRICK RD SUITE 1
MASSAPEQUA NY
11758-6000
US

V. Phone/Fax

Practice location:
  • Phone: 516-541-9000
  • Fax: 516-795-8082
Mailing address:
  • Phone: 516-541-9000
  • Fax: 516-795-8082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number004833
License Number StateNY

VIII. Authorized Official

Name: DR. COREY FOX
Title or Position: PRESIDENT
Credential: DPM
Phone: 516-541-9000