Healthcare Provider Details

I. General information

NPI: 1235588765
Provider Name (Legal Business Name): FAMILY FOOT CARE OF LONG ISLAND, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 02/11/2023
Certification Date: 02/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL DR STE B
PORT JEFFERSON STATION NY
11776-1599
US

IV. Provider business mailing address

1 MEDICAL DR STE B
PORT JEFFERSON STATION NY
11776-1599
US

V. Phone/Fax

Practice location:
  • Phone: 631-928-8383
  • Fax: 631-928-8388
Mailing address:
  • Phone: 631-928-8383
  • Fax: 631-928-8388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENT THOMAS KEMPF
Title or Position: PARTNER
Credential: D.P.M.
Phone: 631-567-2888