Provider Demographics
NPI:1174747497
Name:WEST ISLIP FOOT CARE CENTER
Entity type:Organization
Organization Name:WEST ISLIP FOOT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-661-7400
Mailing Address - Street 1:212 HIGBIE LANE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-2827
Mailing Address - Country:US
Mailing Address - Phone:631-661-7400
Mailing Address - Fax:631-661-3958
Practice Address - Street 1:212 HIGBIE LN
Practice Address - Street 2:SUITE 2
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-2827
Practice Address - Country:US
Practice Address - Phone:631-661-7400
Practice Address - Fax:631-661-3958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5271770001Medicare NSC