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General NPI Number Information
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NPI Number | 1083919286
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Entity Type | Organization
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Legal Business Name | GOLD COAST PODIATRY, PC
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Dates
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Enumeration Date | 01/19/2011
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Last Update Date | 07/27/2021
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Provider Practice Location Address
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Address Line | 222 E MIDDLE COUNTRY RD STE 200
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City | SMITHTOWN
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State | NY
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Zip | 11787-2814
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Country | US
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Telephone | 631-265-7777
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Fax | 631-265-7778
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Provider Business Mailing Address
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Address Line | 222 E MIDDLE COUNTRY RD STE 5
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City | SMITHTOWN
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State | NY
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Zip | 11787-2871
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Country | US
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Telephone | 631-265-7777
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Fax | 631-265-7778
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Authorized Official
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Title or Position | OWNER
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Name | WENDY S. SIEGEL
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Credential | DPM
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Telephone | 631-265-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | N005995
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License Number State | NY
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