Provider Demographics
NPI:1821323155
Name:ORANGETOWN PODIATRY PC
Entity Type:Organization
Organization Name:ORANGETOWN PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CONENELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:845-365-3100
Mailing Address - Street 1:100 DUTCH HILL RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-2197
Mailing Address - Country:US
Mailing Address - Phone:845-365-3100
Mailing Address - Fax:845-365-3253
Practice Address - Street 1:100 DUTCH HILL RD
Practice Address - Street 2:SUITE 270
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-2197
Practice Address - Country:US
Practice Address - Phone:845-365-3100
Practice Address - Fax:845-365-3253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03203876Medicaid
NJ175981Medicare PIN
NY03203876Medicaid
NYA100024024Medicare PIN