Individual provider Active NPI

David Sacrestano, D.P.M.

  • Podiatrist
  • Great Neck, NY
National Provider Identifier
1700062635
Registry record updated Jan 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
N006203 Issued in NY
Practice address
935 Northern Blvd
Suite 107
Great Neck, NY 11021-5316
Phone
(516) 627-5775
Fax
(516) 627-6259
NPI assigned
Jan 10, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 10, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X N006203 NY Primary

Addresses

Primary practice location

935 Northern Blvd
Suite 107
Great Neck, NY 11021-5316

Mailing address

935 Northern Blvd
Suite 107
Great Neck, NY 11021-5316
Phone (516) 627-5775

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
N006203NYMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Footluxe of Long Island Podiatry PC CurrentSince Jan 1, 2021 Accepting new patients
Comprehensive Podiatric Care LLC Podiatrist CurrentSince Nov 1, 2012 Accepting new patients

Locations

474 Westbury Ave
Carle Place, NY 11514
Phone (516) 536-3336

935 Northern Blvd
Ste 107
Great Neck, NY 11021
Phone (516) 627-5775

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1199923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199923200000",
    "number": "1700062635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "935 NORTHERN BLVD",
            "address_2": "SUITE 107",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215316",
            "telephone_number": "516-627-5775",
            "fax_number": "516-627-6259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "935 NORTHERN BLVD",
            "address_2": "SUITE 107",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215316",
            "telephone_number": "516-627-5775",
            "fax_number": "516-627-6259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SACRESTANO",
        "first_name": "DAVID",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-01-10",
        "last_updated": "2008-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NY",
            "license": "N006203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Neck, NY

Sources for this page

Verify at the official NPI Registry.