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General NPI Number Information
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NPI Number | 1366293334
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Entity Type | Organization
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Legal Business Name | LONG ISLAND PODIATRIC SURGERY, P.C.
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Dates
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Enumeration Date | 03/28/2024
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 97 POND PATH
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City | LAKE GROVE
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State | NY
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Zip | 11755-1831
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Country | US
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Telephone | 786-457-4723
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Fax |
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Provider Business Mailing Address
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Address Line | 97 POND PATH
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City | LAKE GROVE
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State | NY
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Zip | 11755-1831
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Country | US
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Telephone | 786-457-4723
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Fax |
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. BILL DALOSIS
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Credential | DPM
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Telephone | 786-457-4723
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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 |
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License Number State |
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