Provider Demographics
NPI:1336564749
Name:OAK TREE PODIATRY, PA
Entity Type:Organization
Organization Name:OAK TREE PODIATRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORKOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:864-934-8396
Mailing Address - Street 1:5 WINCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2626
Mailing Address - Country:US
Mailing Address - Phone:864-934-8396
Mailing Address - Fax:
Practice Address - Street 1:5 WINCHESTER CT
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2626
Practice Address - Country:US
Practice Address - Phone:864-934-8396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC631213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD463Medicare PIN
SCDU7403Medicare PIN