Provider Demographics
NPI:1790882983
Name:SUFFOLK PODIATRY PC
Entity Type:Organization
Organization Name:SUFFOLK PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:CUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-581-8822
Mailing Address - Street 1:111 CARLETON AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-2236
Mailing Address - Country:US
Mailing Address - Phone:631-581-8822
Mailing Address - Fax:631-581-0857
Practice Address - Street 1:111 CARLETON AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-2236
Practice Address - Country:US
Practice Address - Phone:631-581-8822
Practice Address - Fax:631-581-0857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4784750001Medicare NSC
NYPAWE51Medicare ID - Type UnspecifiedGROUP PROVIDER NO.