Provider Demographics
NPI:1033797386
Name:MICHELE AHMADI D.P.M. L.L.C.
Entity Type:Organization
Organization Name:MICHELE AHMADI D.P.M. L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMADI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-735-7847
Mailing Address - Street 1:45 ELWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-3416
Mailing Address - Country:US
Mailing Address - Phone:732-735-7847
Mailing Address - Fax:
Practice Address - Street 1:257 E MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2807
Practice Address - Country:US
Practice Address - Phone:631-982-9343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-30
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty