MEDICARE: DR. GEORGE DANIEL EMMONS DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	N005709	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	130904	OTHER	VYTRA
2	P2654015	OTHER	OXFORD
3	PG8341	OTHER	BLUE CROSS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	2154835	OTHER	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1598842577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE DANIEL EMMONS DPM

Provider Business Mailing Address
First Line	:	388 HAWKINS AVE
Second Line	:
City	:	LAKE RONKONKOMA
State	:	NY
Zip	:	11779-4280
Country	:	US
Telephone Number	:	631-585-0045
Fax Number	:	631-585-7860

Provider Business Practice Location Address
First Line	:	388 HAWKINS AVE
Second Line	:
City	:	LAKE RONKONKOMA
State	:	NY
Zip	:	11779-4280
Country	:	US
Telephone Number	:	631-585-0045
Fax Number	:	631-585-7860

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	09/04/2012

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