Provider Demographics
NPI:1598842577
Name:EMMONS, GEORGE DANIEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:DANIEL
Last Name:EMMONS
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 1:388 HAWKINS AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4280
Mailing Address - Country:US
Mailing Address - Phone:631-585-0045
Mailing Address - Fax:631-585-7860
Practice Address - Street 1:388 HAWKINS AVE
Practice Address - Street 2:
Practice Address - City:LAKE RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4280
Practice Address - Country:US
Practice Address - Phone:631-585-0045
Practice Address - Fax:631-585-7860
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005709213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
130904OtherVYTRA
P2654015OtherOXFORD
PG8341OtherBLUE CROSS
NY02216448Medicaid
2154835OtherUNITED HEALTHCARE
PG8341OtherBLUE CROSS
2154835OtherUNITED HEALTHCARE