Provider Demographics
NPI:1285887422
Name:DYKER PARK FOOTCARE, PLLC.
Entity type:Organization
Organization Name:DYKER PARK FOOTCARE, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PASQUALE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DESANTO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-745-6220
Mailing Address - Street 1:8404 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3302
Mailing Address - Country:US
Mailing Address - Phone:718-745-6220
Mailing Address - Fax:718-745-6229
Practice Address - Street 1:8404 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3302
Practice Address - Country:US
Practice Address - Phone:718-745-6220
Practice Address - Fax:718-745-6229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006056213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty