Provider Demographics
NPI:1407919673
Name:DITTMAR, FRANK (DPM)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:
Last Name:DITTMAR
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 1:578 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-6003
Mailing Address - Country:US
Mailing Address - Phone:631-893-7030
Mailing Address - Fax:631-893-7066
Practice Address - Street 1:578 E SUNRISE HIGHWAY
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-6003
Practice Address - Country:US
Practice Address - Phone:631-893-7030
Practice Address - Fax:631-893-7066
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004074213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P44221Medicare ID - Type Unspecified
T51388Medicare UPIN