Provider Demographics
NPI:1275057341
Name:FOOTLUXE OF LONG ISLAND LLC
Entity Type:Organization
Organization Name:FOOTLUXE OF LONG ISLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAFFAELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUFFOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-342-0673
Mailing Address - Street 1:70 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4225
Mailing Address - Country:US
Mailing Address - Phone:516-536-3336
Mailing Address - Fax:516-858-1125
Practice Address - Street 1:70 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4225
Practice Address - Country:US
Practice Address - Phone:516-536-3336
Practice Address - Fax:516-858-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006550OtherLICENSE