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General NPI Number Information
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NPI Number | 1093907651
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Entity Type | Organization
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Legal Business Name | R REPLOGLE AND F DITTMAR PTR
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 03/15/2012
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Provider Practice Location Address
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Address Line | 578 SUNRISE HWY
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City | WEST BABYLON
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State | NY
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Zip | 11704-6003
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Country | US
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Telephone | 631-893-7030
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Fax |
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Provider Business Mailing Address
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Address Line | 578 SUNRISE HWY
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City | WEST BABYLON
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State | NY
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Zip | 11704-6003
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Country | US
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Telephone | 631-893-7030
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Fax |
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | DR. FRANK DITTMAR
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Credential | D.P.M.
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Telephone | 631-893-7030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N004074
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License Number State | NY
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