Provider Demographics
NPI:1073783411
Name:TWIN COUNTY PODIATRY-PC
Entity Type:Organization
Organization Name:TWIN COUNTY PODIATRY-PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:HERBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-378-0184
Mailing Address - Street 1:49 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3837
Mailing Address - Country:US
Mailing Address - Phone:516-378-0184
Mailing Address - Fax:516-378-0294
Practice Address - Street 1:49 CHURCH ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3837
Practice Address - Country:US
Practice Address - Phone:516-378-0184
Practice Address - Fax:516-378-0294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5653570001Medicare NSC