Provider Demographics
NPI:1235310236
Name:DANIEL GIRARDI, DPM PC
Entity Type:Organization
Organization Name:DANIEL GIRARDI, DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRARDI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-667-4444
Mailing Address - Street 1:1992 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-2701
Mailing Address - Country:US
Mailing Address - Phone:631-667-4444
Mailing Address - Fax:631-667-0601
Practice Address - Street 1:1992 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-2701
Practice Address - Country:US
Practice Address - Phone:631-667-4444
Practice Address - Fax:631-667-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003925213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00933679Medicaid
NY00933679Medicaid