Provider Demographics
NPI:1720266208
Name:NORTH FORK PODIATRY ASSOCIATES
Entity Type:Organization
Organization Name:NORTH FORK PODIATRY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-765-6777
Mailing Address - Street 1:44210 ROUTE 48
Mailing Address - Street 2:P.O. BOX 1146
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-1146
Mailing Address - Country:US
Mailing Address - Phone:631-765-6777
Mailing Address - Fax:631-765-6933
Practice Address - Street 1:44210 ROUTE 48
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-1146
Practice Address - Country:US
Practice Address - Phone:631-765-6777
Practice Address - Fax:631-765-6933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTIN
NY5500180001Medicare NSC
NY=========OtherTIN