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General NPI Number Information
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NPI Number | 1326771213
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Entity Type | Organization
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Legal Business Name | LITTLE NECK PODIATRY, P.C.
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Dates
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Enumeration Date | 07/07/2022
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Last Update Date | 07/07/2022
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Provider Practice Location Address
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Address Line | 1149 OLD COUNTRY RD STE B1
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City | RIVERHEAD
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State | NY
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Zip | 11901-2060
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Country | US
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Telephone | 631-740-9549
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Fax |
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Provider Business Mailing Address
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Address Line | 1149 OLD COUNTRY RD STE B1
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City | RIVERHEAD
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State | NY
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Zip | 11901-2060
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DPM
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Name | BERNADETTE PUPILLA
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Credential |
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Telephone | 631-513-6159
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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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