| Organization Name: | DANIEL KORMYLO, DPM |
| NPI Number: | 1083885461 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DANIEL KORMYLO (OWNER) |
| Mailing Address: | 745 Route 25a Rocky Point |
| State: | NY US |
| Postal Code: | 117789552 |
| Phone Number: | 6317448282 |
| Fax Number: | 6318215583 |
| NPI Enumeration Date: | 03/13/2008 |
| NPI Last Update Date: | 06/19/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | N004250 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |