Healthcare Provider Details

I. General information

NPI: 1720266208
Provider Name (Legal Business Name): NORTH FORK PODIATRY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44210 ROUTE 48
SOUTHOLD NY
11971-1146
US

IV. Provider business mailing address

44210 ROUTE 48 P.O. BOX 1146
SOUTHOLD NY
11971-1146
US

V. Phone/Fax

Practice location:
  • Phone: 631-765-6777
  • Fax: 631-765-6933
Mailing address:
  • Phone: 631-765-6777
  • Fax: 631-765-6933

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: OWNER
Credential: DPM
Phone: 631-765-6777