Provider Demographics
NPI:1720095706
Name:WINSTON, WAYNE (DPM)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:WINSTON
Suffix:
Gender:M
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:P.O.BOX 7610
Mailing Address - Street 2:ATTENTIONI: DAWN DEMARCO
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530
Mailing Address - Country:US
Mailing Address - Phone:516-683-3900
Mailing Address - Fax:516-292-3003
Practice Address - Street 1:135 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550
Practice Address - Country:US
Practice Address - Phone:516-683-3900
Practice Address - Fax:516-292-3003
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006104-01213ES0103X
NY006104-01261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery