Provider Demographics
NPI:1053776096
Name:COUNTRY FOOT CARE PODIATRY PLLC
Entity type:Organization
Organization Name:COUNTRY FOOT CARE PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROOK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-741-3338
Mailing Address - Street 1:173 MINEOLA BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2528
Mailing Address - Country:US
Mailing Address - Phone:516-741-3338
Mailing Address - Fax:516-506-7123
Practice Address - Street 1:173 MINEOLA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2528
Practice Address - Country:US
Practice Address - Phone:516-741-3338
Practice Address - Fax:516-506-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty