| Doctor Name: | DR. EDWARD C KORMYLO |
| NPI Number: | 1134373467 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | 65 006296 |
| Business Practice Address: | 285 Sills Rd Bldg. 15 Suite D East Patchogue, NY - 117724869 |
| Business Phone Number: | 6316545566 |
| Business Fax Number: | 6316548250 |
| Mailing Address: | 285 Sills Rd, Bldg. 15 Suite D EAST PATCHOGUE |
| State: | NY |
| Postal Code: | 117724869 |
| Phone Number: | 6316545566 |
| Fax Number: | 6316548250 |
| NPI Enumeration Date: | 11/13/2008 |
| NPI Last Update Date: | 05/01/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 65 006296 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |