Provider Demographics
NPI:1083707491
Name:COMBA, JOSEPH R (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:R
Last Name:COMBA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 GRANNY RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2130
Mailing Address - Country:US
Mailing Address - Phone:631-736-4272
Mailing Address - Fax:631-716-0980
Practice Address - Street 1:186 GRANNY RD
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2130
Practice Address - Country:US
Practice Address - Phone:631-736-4272
Practice Address - Fax:631-716-0980
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004469-1213E00000X, 213EP0504X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Not Answered213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
Not Answered213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Not Answered213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
Not Answered213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Not Answered213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01129359Medicaid
NY3657560001OtherDME-MEDICARE #
NY0019389OtherGHI #
NY01129359Medicaid
NY3657560001OtherDME-MEDICARE #