SOUTH SHORE PODIATRY PLLC NPI 1457735094

NPI Information

NPI: 1457735094
Provider Name: SOUTH SHORE PODIATRY, PLLC
Classification: Podiatrist - 213ES0131X
Entity Type: Organization

Specialization: Foot Surgery

CLIA Number: 33D2086356

Address:
20 HICKSVILLE RD
SUITE 2
MASSAPEQUA, NY
ZIP 11758
Phone: (516) 744-0354
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SOUTH SHORE PODIATRY, PLLC is a foot surgery podiatrist in Massapequa, NY. SOUTH SHORE PODIATRY, PLLC NPI is 1457735094. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

20 HICKSVILLE RD
SUITE 2
MASSAPEQUA, NY
ZIP 11758-819
Phone: (516) 744-0354
Fax: (855) 959-1613

The provider's authorized official is Mital B Patel .
The authorized official title is Podiatrist and has the following contact phone number (516) 590-7744.

The CLIA number assigned to this NPI record is 33D2086356 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/14/2015 and was last updated on 3/14/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	213ES0131X	Podiatrist	Foot Surgery	N006053-1	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	A100127791	OTHER	NEW YORK	MEDICARE PTAN
2	PK6781	OTHER	NEW YORK	MEDICARE
3	02669029	MEDICAID	NEW YORK
4	7479080001	MEDICARE NSC	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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