Provider Demographics
NPI:1851824544
Name:COUNTRY FOOT CARE PODIATRY
Entity Type:Organization
Organization Name:COUNTRY FOOT CARE PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-741-3338
Mailing Address - Street 1:655-23 MONTAUK HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3154
Mailing Address - Country:US
Mailing Address - Phone:631-475-3030
Mailing Address - Fax:631-475-3036
Practice Address - Street 1:173 MINEOLA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2528
Practice Address - Country:US
Practice Address - Phone:516-741-3338
Practice Address - Fax:516-506-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty