| Organization Name: | SUFFOLK COUNTY FOOT CARE PLLC |
| NPI Number: | 1114023660 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEPHEN B RAVITZ (PODIATRIST) |
| Mailing Address: | 63 Main St Kings Park |
| State: | NY US |
| Postal Code: | 117542706 |
| Phone Number: | 6312694600 |
| Fax Number: | 6312690801 |
| NPI Enumeration Date: | 09/15/2006 |
| NPI Last Update Date: | 04/29/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP1100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Podiatric |
| Taxonomy Definition: | |