Organization
SUFFOLK FOOT AND ANKLE
Active
Parent organization
EAST PATCHOGUE PODIATRY P.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
EAST PATCHOGUE PODIATRY P.C.
Authorized official
DR. EDWARD J KORMYLO CPM (PHYSICIAN)
(631) 654-5566
Entity
Organization
Contact information
Practice address
1641 ROUTE 112, MEDFORD, NY 11763-3663
(631) 447-0800
Mailing address
285 SILLS RD BLDG 15, EAST PATCHOGUE, NY 11772-4869
(631) 654-5566
(631) 654-8250
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
—
—
Other
Enumeration date
10/25/2018
Last updated
10/25/2018
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