| Organization Name: | GARY P MILACK DPM PC |
| NPI Number: | 1194084913 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GARY PAUL MILACK (OWNER) |
| Mailing Address: | 45 Route 25a Suite D-1 Shoreham |
| State: | NY US |
| Postal Code: | 117861389 |
| Phone Number: | 6317440022 |
| Fax Number: | 6317440802 |
| NPI Enumeration Date: | 05/14/2012 |
| NPI Last Update Date: | 05/14/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP1100X |
| License Number: | 002730 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Podiatric |
| Taxonomy Definition: | |