Deer Park South Shore Podiatry PC
Organization Active NPI Podiatric Clinic/Center · North Babylon, NY
NPI 1821765736 · NPPES record last updated Aug 27, 2021
Key facts
- NPI
- 1821765736
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Podiatric Clinic/Center 261QP1100X
- Legal business name
- DEER PARK SOUTH SHORE PODIATRY PC
- Practice address
- 1428 Deer Park Ave
North Babylon, NY 11703-1623 - Phone
- (631) 586-3388
- Fax
- (631) 586-3394
- NPI assigned
- Aug 27, 2021
- Organization subpart
- No
Authorized official
- Name
- Ronald Kim, DPM
- Title
- Owner
- Phone
- (631) 586-3388
Practitioners 1
-
Ronald Kim, DPM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20211007000673 | NY | Part B Supplier - Clinic/Group Practice | 4183022098 |
Receives reassigned benefits from 1 practitioner Practice locations: North Babylon, NY |
| O20211220002603 | NY | DME Supplier - Physician - Podiatry | 4183022098 | Practice locations: North Babylon, NY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatric Clinic/Center | 261QP1100X | Yes |
Addresses
Primary practice location
1428 Deer Park Ave
North Babylon, NY 11703-1623
Mailing address
1428 Deer Park Ave
North Babylon, NY 11703-1623
Phone (631) 586-3388
Other providers in North Babylon, NY
- Allison Darling
- Maria Esther Davila
- Susanna De Jesus
- Dee'S 4 Awesome Kids Inc
- Deer Park Podiatry
- Deer Park Super Drugs Inc
- Frank Anthony Dellisanti
- Dental Smiles for Kids, LLC
- Valerie Derose
- Wislande Derose
All providers in North Babylon, NY · Podiatric Clinic/Center in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.