Provider Demographics
NPI:1538554571
Name:MICHAEL J SKONIECZNY DPM LLC
Entity type:Organization
Organization Name:MICHAEL J SKONIECZNY DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SKONIECZNY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:914-474-4638
Mailing Address - Street 1:237 COLUMBUS AVE
Mailing Address - Street 2:APT 2A
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2534
Mailing Address - Country:US
Mailing Address - Phone:914-474-4638
Mailing Address - Fax:
Practice Address - Street 1:1200 WATERS PL
Practice Address - Street 2:SUITE M101
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2728
Practice Address - Country:US
Practice Address - Phone:718-863-0244
Practice Address - Fax:718-863-0246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006630-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty