# SOUTH ISLAND PODIATRY SPECIALISTS,PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376607713
- **Authorized official:** DR. WAYNE JOSEPH BODAMER D.P.M. (PRESIDENT)
- **Authorized official phone:** (631) 447-0800

## Contact information

- **Practice address:** 1641 ROUTE 112, MEDFORD, NY 11763-3635
- **Practice address phone:** (631) 447-0800
- **Practice address fax:** (631) 447-0801
- **Mailing address:** 1641 ROUTE 112, MEDFORD, NY 11763-3635
- **Mailing address phone:** (631) 447-0800
- **Mailing address fax:** (631) 447-0801

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | N0-3889 | NY | Yes |

## Other

- **Enumeration date:** 12/20/2006
- **Last updated:** 06/13/2008