Healthcare Provider Details

I. General information

NPI: 1609565019
Provider Name (Legal Business Name): IFAA ORTHOTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MONTAUK HWY STE 100
WEST ISLIP NY
11795-4910
US

IV. Provider business mailing address

1111 MONTAUK HWY STE 100
WEST ISLIP NY
11795-4910
US

V. Phone/Fax

Practice location:
  • Phone: 631-422-4450
  • Fax:
Mailing address:
  • Phone: 631-422-4450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY FERRARO
Title or Position: DPM
Credential:
Phone: 631-422-4450