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General NPI Number Information
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NPI Number | 1790965713
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Entity Type | Organization
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Legal Business Name | DISCOVER PODIATRY, P.C.
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 2111 UNION BLVD
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City | BAY SHORE
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State | NY
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Zip | 11706-8017
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Country | US
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Telephone | 631-206-3106
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Fax | 631-206-3108
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Provider Business Mailing Address
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Address Line | 21 STACEY LN
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City | SMITHTOWN
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State | NY
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Zip | 11787-2354
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Country | US
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Telephone | 631-206-3106
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Fax | 631-206-3108
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DANA BARRY SIEGEL
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Credential | D.P.M.
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Telephone | 631-206-3106
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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 | 005107
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License Number State | NY
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