Provider Demographics
NPI:1194084913
Name:GARY P MILACK DPM PC
Entity type:Organization
Organization Name:GARY P MILACK DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MILACK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-744-0022
Mailing Address - Street 1:45 ROUTE 25A
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786-1389
Mailing Address - Country:US
Mailing Address - Phone:631-744-0022
Mailing Address - Fax:531-744-0803
Practice Address - Street 1:45 ROUTE 25A
Practice Address - Street 2:SUITE D-1
Practice Address - City:SHOREHAM
Practice Address - State:NY
Practice Address - Zip Code:11786-1389
Practice Address - Country:US
Practice Address - Phone:631-744-0022
Practice Address - Fax:631-744-0802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARY P MILACK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002730261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric