Provider Demographics
NPI:1386724516
Name:GERARD FURST AND MARJORIE RAVITZ DPM PC
Entity type:Organization
Organization Name:GERARD FURST AND MARJORIE RAVITZ DPM PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-724-1166
Mailing Address - Street 1:260 MIDDLE COUNTRY ROAD
Mailing Address - Street 2:STE 104
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787
Mailing Address - Country:US
Mailing Address - Phone:631-724-1166
Mailing Address - Fax:631-724-4130
Practice Address - Street 1:260 MIDDLE COUNTRY ROAD
Practice Address - Street 2:STE 104
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2982
Practice Address - Country:US
Practice Address - Phone:631-724-1166
Practice Address - Fax:631-724-4130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCJ0020OtherRR MEDICARE
NY0044604OtherGHI
NY0044604OtherGHI