Provider Demographics
NPI:1336534221
Name:BELLMORE PODIATRY PC
Entity Type:Organization
Organization Name:BELLMORE PODIATRY PC
Other - Org Name:C/O ANDREA CUNHA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CUNHA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-221-4311
Mailing Address - Street 1:3214 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3831
Mailing Address - Country:US
Mailing Address - Phone:516-526-1661
Mailing Address - Fax:
Practice Address - Street 1:2428 MERRICK RD
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5745
Practice Address - Country:US
Practice Address - Phone:516-221-4311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005719213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty