Healthcare Provider Details

I. General information

NPI: 1447432935
Provider Name (Legal Business Name): SHELTER ISLAND PODIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2A HUDSON AVENUE # 1023
SHELTER ISLAND NY
11964-1023
US

IV. Provider business mailing address

PO BOX 1023 2A HUDSON AVENUE
SHELTER ISLAND NY
11964-1023
US

V. Phone/Fax

Practice location:
  • Phone: 631-749-2222
  • Fax: 631-749-4033
Mailing address:
  • Phone: 631-749-2222
  • Fax: 631-749-4033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBIN ROSS
Title or Position: PARTNER
Credential: DPM
Phone: 631-749-2222