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General NPI Number Information
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NPI Number | 1003281486
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Entity Type | Organization
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Legal Business Name | COUNTRY FOOT CARE PODIATRY PLLC
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 12/11/2015
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Provider Practice Location Address
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Address Line | 479 WILLIS AVE
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City | WILLISTON PARK
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State | NY
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Zip | 11596-1725
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Country | US
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Telephone | 516-294-8877
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Fax | 516-294-8878
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Provider Business Mailing Address
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Address Line | 173 MINEOLA BLVD
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City | MINEOLA
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State | NY
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Zip | 11501-2528
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Country | US
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Telephone | 516-741-3338
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Fax | 516-506-7123
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN BROOK
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Credential | DPM
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Telephone | 516-741-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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