Healthcare Provider Details

I. General information

NPI: 1144408972
Provider Name (Legal Business Name): MARINE PARK PODIATRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204-08 ROCKAWAY POINT BLVD
ROCKAWAY POINT NY
11697-1115
US

IV. Provider business mailing address

204-08 ROCKAWAY POINT BLVD
ROCKAWAY POINT NY
11697-1115
US

V. Phone/Fax

Practice location:
  • Phone: 718-318-5531
  • Fax: 718-318-0157
Mailing address:
  • Phone: 718-318-5531
  • Fax: 718-318-0157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberN004621
License Number StateNY

VIII. Authorized Official

Name: DR. ELIZABETH S. MURPHY
Title or Position: PRES./OWNER
Credential:
Phone: 718-318-5531