Long Island Podiatry PC

Primary specialty

Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X

License

N004211 Issued in NY

Legal business name

LONG ISLAND PODIATRY PC

Practice address

56340 Main Road
Southold, NY 11725-3805

Phone

(631) 765-2772

NPI assigned

Aug 27, 2008

Last updated

Apr 10, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael Lawrence Brody, DPMNPI 1770526774

Title

President

Phone

(631) 549-3668

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Lawrence Brody, DPM

  • Podiatrist
  • Southold, NY
  • NPI 1770526774
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365552000000",
    "number": "1063669430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 EVELYN DR",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117253805",
            "telephone_number": "631-549-3668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56340 MAIN ROAD",
            "city": "SOUTHOLD",
            "state": "NY",
            "postal_code": "117253805",
            "telephone_number": "631-765-2772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG ISLAND PODIATRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-27",
        "last_updated": "2013-04-10",
        "status": "A",
        "authorized_official_last_name": "BRODY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "LAWRENCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-549-3668",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "NY",
            "license": "N004211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Kozlowska, MS,L.AC.
• Robert T Kroepel, DDS
• Kathryn Krukowski
• William Lappe, LPN
• Lisa C. Deluca, LCSW, PLLC
• Amanda Mackillop, NP
• Mako Residence
• Janet Elaine Marin, PT
• Amy McGrath, SLP CCC
• Katherine Elizabeth Meehan, PSY.D

• Primary Podiatric Medicine Podiatrist in Southold, NY
• Providers in Southold, NY by specialty
• Primary Podiatric Medicine Podiatrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.