Provider Demographics
NPI:1447432935
Name:SHELTER ISLAND PODIATRY
Entity Type:Organization
Organization Name:SHELTER ISLAND PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-749-2222
Mailing Address - Street 1:PO BOX 1023
Mailing Address - Street 2:2A HUDSON AVENUE
Mailing Address - City:SHELTER ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11964-1023
Mailing Address - Country:US
Mailing Address - Phone:631-749-2222
Mailing Address - Fax:631-749-4033
Practice Address - Street 1:2A HUDSON AVENUE
Practice Address - Street 2:# 1023
Practice Address - City:SHELTER ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11964-1023
Practice Address - Country:US
Practice Address - Phone:631-749-2222
Practice Address - Fax:631-749-4033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6023710001Medicare NSC
NYPDW481Medicare PIN