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General NPI Number Information
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NPI Number | 1174634281
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE PODIATRY ASSOCIATES DPM PC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 04/09/2009
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Provider Practice Location Address
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Address Line | 46 ROUTE 25A STE 6
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City | EAST SETAUKET
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State | NY
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Zip | 11733
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Country | US
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Telephone | 631-689-0202
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Fax | 631-689-2686
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Provider Business Mailing Address
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Address Line | 35 SHORE RD
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City | EAST SETAUKET
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State | NY
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Zip | 11733-3920
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Country | US
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Telephone | 631-689-0202
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Fax | 631-689-2686
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BEN R DIMICHINO
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Credential | DPM
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Telephone | 631-689-0202
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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 |
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License Number State |
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