Organization
SOUTH ISLAND PODIATRY SPECIALISTS,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WAYNE JOSEPH BODAMER D.P.M. (PRESIDENT)
(631) 447-0800
Entity
Organization
Contact information
Practice address
1641 ROUTE 112, MEDFORD, NY 11763-3635
(631) 447-0800
(631) 447-0801
Mailing address
1641 ROUTE 112, MEDFORD, NY 11763-3635
(631) 447-0800
(631) 447-0801
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
N0-3889
NY
Other
Enumeration date
12/20/2006
Last updated
06/13/2008
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