Healthcare Provider Details

I. General information

NPI: 1639274012
Provider Name (Legal Business Name): JOHN T SOTTILE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 CROMWELL AVE
STATEN ISLAND NY
10304-3944
US

IV. Provider business mailing address

89 CROMWELL AVE
STATEN ISLAND NY
10304-3944
US

V. Phone/Fax

Practice location:
  • Phone: 718-980-0126
  • Fax:
Mailing address:
  • Phone: 718-980-0126
  • Fax: 718-980-9252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN004912
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: