Provider Demographics
NPI:1205133592
Name:1795 CONEY ISLAND PODIATRY PC
Entity type:Organization
Organization Name:1795 CONEY ISLAND PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NECHAMA
Authorized Official - Middle Name:V
Authorized Official - Last Name:MUCHNIK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-645-6705
Mailing Address - Street 1:1795 CONEY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6557
Mailing Address - Country:US
Mailing Address - Phone:718-645-6705
Mailing Address - Fax:718-645-6707
Practice Address - Street 1:1795 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6557
Practice Address - Country:US
Practice Address - Phone:718-645-6705
Practice Address - Fax:718-645-6707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty