Provider Demographics
NPI:1174634281
Name:COMPREHENSIVE PODIATRY ASSOCIATES DPM PC
Entity Type:Organization
Organization Name:COMPREHENSIVE PODIATRY ASSOCIATES DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DIMICHINO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-689-0202
Mailing Address - Street 1:35 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3920
Mailing Address - Country:US
Mailing Address - Phone:631-689-0202
Mailing Address - Fax:631-689-2686
Practice Address - Street 1:46 ROUTE 25A
Practice Address - Street 2:STE 6
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733
Practice Address - Country:US
Practice Address - Phone:631-689-0202
Practice Address - Fax:631-689-2686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
792279OtherUNITED HEALTH CARE
114212OtherVYTRA
4450726OtherAETNA
P2545365OtherOXFORD
1C1330OtherHEALTHNET
NY01590385Medicaid
AA47838OtherMDNY
P2545365OtherOXFORD
1C1330OtherHEALTHNET
U18040Medicare UPIN