Provider Demographics
NPI:1083348791
Name:PLYMOUTH PODIATRY PC
Entity Type:Organization
Organization Name:PLYMOUTH PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SKONIECZNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-747-1973
Mailing Address - Street 1:116 COURT ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-8710
Mailing Address - Country:US
Mailing Address - Phone:508-747-1973
Mailing Address - Fax:508-747-5392
Practice Address - Street 1:68 CAMP ST STE 2
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3048
Practice Address - Country:US
Practice Address - Phone:774-470-4507
Practice Address - Fax:774-810-7189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty