Organization
NEW IMAGE PODIATRY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LUIS A VIDAL DPM (PODIATRIST)
(631) 864-7380
Entity
Organization
Contact information
Practice address
6143 JERICHO TPKE, SUITE 102, COMMACK, NY 11725-2809
(631) 864-7380
(631) 864-7381
Mailing address
6143 JERICHO TPKE, SUITE 102, COMMACK, NY 11725-2809
(631) 864-7380
(631) 864-7381
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
N006167
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02832759
—
NY
01
—
07800
MEDICARE GHI
NY
01
—
PDWF01
NATIONAL GOVERNMENT SERVICES(EMPIRE)
NY
Enumeration date
08/15/2006
Last updated
04/28/2008
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