Provider Demographics
NPI:1134373467
Name:KORMYLO, EDWARD C (DPM)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:C
Last Name:KORMYLO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:285 SILLS RD
Mailing Address - Street 2:BLDG. 15 SUITE D
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4869
Mailing Address - Country:US
Mailing Address - Phone:631-654-5566
Mailing Address - Fax:631-654-8250
Practice Address - Street 1:285 SILLS RD
Practice Address - Street 2:BLDG. 15 SUITE D
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4869
Practice Address - Country:US
Practice Address - Phone:631-654-5566
Practice Address - Fax:631-654-8250
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY65 006296213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery