| Organization Name: | COUNTRY FOOT CARE PODIATRY PLLC |
| NPI Number: | 1053776096 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEVEN D BROOK (OWNER) |
| Mailing Address: | 173 Mineola Blvd Suite 201 Mineola |
| State: | NY US |
| Postal Code: | 115012528 |
| Phone Number: | 5167413338 |
| Fax Number: | 5165067123 |
| NPI Enumeration Date: | 12/17/2015 |
| NPI Last Update Date: | 12/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |