Provider Demographics
NPI:1629166483
Name:LONG ISLAND FOOT SPECIALIST P C
Entity Type:Organization
Organization Name:LONG ISLAND FOOT SPECIALIST P C
Other - Org Name:LONG ISLAND FOOT SPECIALIST P C
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:LEVENSTIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-226-3668
Mailing Address - Street 1:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-0169
Mailing Address - Country:US
Mailing Address - Phone:631-226-3668
Mailing Address - Fax:
Practice Address - Street 1:481 W MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-5528
Practice Address - Country:US
Practice Address - Phone:631-226-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0059441213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPJ108PEA81OtherINDIVIDUAL PIN - LIFS
NYPJ1081OtherINDIVIDUAL PIN - TODD L.
NYPEWA81OtherGROUP PIN - LIFS
NYPJ1081OtherINDIVIDUAL PIN - TODD L.
NYPEWA81Medicare ID - Type Unspecified