Provider Demographics
NPI:1235399841
Name:GEORGE M. DEVITO DPM PC
Entity Type:Organization
Organization Name:GEORGE M. DEVITO DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEVITO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-650-5308
Mailing Address - Street 1:384 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2821
Mailing Address - Country:US
Mailing Address - Phone:631-650-5308
Mailing Address - Fax:
Practice Address - Street 1:384 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2821
Practice Address - Country:US
Practice Address - Phone:631-650-5308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty