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General NPI Number Information
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NPI Number | 1699776674
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Entity Type | Individual
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Provider Name | DANIEL KORMYLO DPM
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Gender | Male
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 745 RT 25A SUITE B
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City | ROCKY POINT
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State | NY
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Zip | 11778-0969
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Country | US
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Telephone | 631-744-8282
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Fax | 631-821-5583
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Provider Business Mailing Address
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Address Line | PO BOX 5153
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City | ROCKY POINT
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State | NY
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Zip | 11778-0969
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Country | US
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Telephone | 631-744-8282
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Fax | 631-821-5583
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | N004250
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 004250
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License Number State | NY
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