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Organization

SUFFOLK COUNTY FOOT CARE PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. STEPHEN B RAVITZ DPM (PODIATRIST)
(631) 269-4600
Entity
Organization

Contact information

Practice address
63 MAIN ST, KINGS PARK, NY 11754-2706
(631) 269-4600
(631) 269-0801
Mailing address
63 MAIN ST, KINGS PARK, NY 11754-2706
(631) 269-4600
(631) 269-0801

Taxonomy

Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01271269
CAID
05
01271269
NY
01
02216448
CAID
01
130904
VYTRA
01
19966
VYTRA
01
2154835
UNITED HEALTHCARE
01
6299184
GHI
01
9653126
GHI
01
CS267
OXFORD
01
P2654015
OXFORD
01
P55031
UNITED HEALTHCARE
Enumeration date
09/15/2006
Last updated
04/29/2011
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