Provider Demographics
NPI:1689171324
Name:KINGS PARK PODIATRY PLLC
Entity Type:Organization
Organization Name:KINGS PARK PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:F
Authorized Official - Last Name:GAROFALO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-457-8552
Mailing Address - Street 1:160 E NORTHPORT RD
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-2541
Mailing Address - Country:US
Mailing Address - Phone:631-269-6060
Mailing Address - Fax:631-269-7173
Practice Address - Street 1:160 E NORTHPORT RD
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-2541
Practice Address - Country:US
Practice Address - Phone:631-269-6060
Practice Address - Fax:631-269-7173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005196213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty