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General NPI Number Information
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NPI Number | 1194084913
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Entity Type | Organization
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Legal Business Name | GARY P MILACK DPM PC
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Dates
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Enumeration Date | 05/14/2012
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Last Update Date | 05/14/2012
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Provider Practice Location Address
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Address Line | 45 ROUTE 25A SUITE D-1
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City | SHOREHAM
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State | NY
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Zip | 11786-1389
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Country | US
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Telephone | 631-744-0022
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Fax | 631-744-0802
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Provider Business Mailing Address
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Address Line | 45 ROUTE 25A SUITE D-1
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City | SHOREHAM
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State | NY
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Zip | 11786-1389
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Country | US
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Telephone | 631-744-0022
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Fax | 531-744-0803
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Authorized Official
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Title or Position | OWNER
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Name | DR. GARY PAUL MILACK
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Credential | DPM
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Telephone | 631-744-0022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number | 002730
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License Number State | NY
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