Provider Demographics
NPI:1639804834
Name:ISLAND FOOT AND ANKLE
Entity Type:Organization
Organization Name:ISLAND FOOT AND ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:VERENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEUTEL DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-526-2768
Mailing Address - Street 1:1111 MONTAUK HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4910
Mailing Address - Country:US
Mailing Address - Phone:631-422-4450
Mailing Address - Fax:
Practice Address - Street 1:1399 FRANKLIN AVE STE 304
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1678
Practice Address - Country:US
Practice Address - Phone:631-422-4450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-21
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