Organization
SOUTH SHORE PODIATRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MITAL B PATEL DPM (PODIATRIST)
(516) 590-7744
Entity
Organization
Contact information
Practice address
20 HICKSVILLE RD, SUITE 2, MASSAPEQUA, NY 11758-5819
(516) 744-0354
(855) 959-1613
Mailing address
20 HICKSVILLE RD, SUITE 2, MASSAPEQUA, NY 11758-5819
(516) 744-0354
(855) 959-1613
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
N006053-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02669029
—
NY
01
—
A100127791
MEDICARE PTAN
NY
01
—
PK6781
MEDICARE
NY
Enumeration date
07/14/2015
Last updated
03/14/2016
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