Provider Demographics
NPI:1942242268
Name:KIRELL PODIATRY ASSOCIATES
Entity Type:Organization
Organization Name:KIRELL PODIATRY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:KIRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-372-4693
Mailing Address - Street 1:22 HARDWICK DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4550
Mailing Address - Country:US
Mailing Address - Phone:631-678-1019
Mailing Address - Fax:
Practice Address - Street 1:2833 OCEAN PKWY
Practice Address - Street 2:SUITE 'A'
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7857
Practice Address - Country:US
Practice Address - Phone:718-372-4693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003755213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP0W011Medicare ID - Type UnspecifiedMEDICARE GROUP ID