Provider Demographics
NPI:1922036466
Name:FOX, COREY (DPM)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:
Last Name:FOX
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6000
Mailing Address - Country:US
Mailing Address - Phone:516-541-9000
Mailing Address - Fax:516-795-8082
Practice Address - Street 1:4160 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6000
Practice Address - Country:US
Practice Address - Phone:516-541-9000
Practice Address - Fax:516-795-8082
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004833213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01653290Medicaid
NYP53401Medicare ID - Type Unspecified
NYU18054Medicare UPIN
NY01653290Medicaid