Michael Craig Penchuk, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

005080 Issued in NY

Practice address

2125 Holland Way
Merrick, NY 11566-5421

Phone

(516) 771-7090

NPI assigned

Sep 30, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Temple University School of Podiatric Medicine, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1159574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1336232719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2125 HOLLAND WAY",
            "city": "MERRICK",
            "state": "NY",
            "postal_code": "115665421",
            "telephone_number": "516-771-7090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2125 HOLLAND WAY",
            "city": "MERRICK",
            "state": "NY",
            "postal_code": "115665421",
            "telephone_number": "516-771-7090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENCHUK",
        "first_name": "MICHAEL",
        "middle_name": "CRAIG",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NY",
            "license": "005080",
            "primary": true
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NJ",
            "license": "25MD00225600",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD HEALTH PLANS",
            "identifier": "P1100931",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "6200811",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anita F Pasternack, DDS
• Mesha Patel, OD
• Rochelle A Patti, MS
• Sarah Pazmino, OTR/L
• Pediatric Nurse Practitioner, PLLC
• Dessiree Marie Pendleton, LMSW
• Roseann Penna
• Jodi Samantha Penstein, OTR/L
• Kathryn Perafan, MSED
• Kylie Pernice, LMSW

• Podiatrist in Merrick, NY
• Providers in Merrick, NY by specialty
• Podiatrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.