Individual
EDWARD J KORMYLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
33 MEDFORD AVE STE D, PATCHOGUE, NY 11772-1222
(631) 687-4190
(631) 687-4199
Mailing address
14 WALL ST FL 9, NEW YORK, NY 10005-2178
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
N003100
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00588743
—
NY
01
—
480015120
MEDICARE RAILROAD
NY
Enumeration date
02/16/2006
Last updated
10/28/2022
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