Provider Demographics
NPI:1245335108
Name:FORKOSH, IDIT R (DPM)
Entity type:Individual
Prefix:DR
First Name:IDIT
Middle Name:R
Last Name:FORKOSH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5237
Mailing Address - Country:US
Mailing Address - Phone:718-758-9150
Mailing Address - Fax:
Practice Address - Street 1:3600 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5237
Practice Address - Country:US
Practice Address - Phone:718-758-9150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005510213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4C1212OtherHEALTHNET
NY6299196OtherGHI
NY5425584OtherBCE EMERGIS (UP &UP)
FI5510OtherATLANTIS
NYP05510-4WOtherWORKER'S COMP
NY163211OtherELDERPLAN
NYN005510OtherMAGNACARE
NY1892417OtherFIRST HEALTH PINS
NYHIPOtherN005510
NYN005510OtherHORIZON HEALTHCARE
NYPB5341OtherBLUE CHOICE
NY02039710Medicaid
NYN005510Other1199 PCS
NY030005510NY01OtherANTHEM
NYN005510OtherHEALTHFIRST
NYN005510OtherCAREPLUS
NYP2171265OtherOXFORD
NY030005510NY01OtherANTHEM
FI5510OtherATLANTIS