Basic Information
| Provider Information | |||||||||
| NPI: | 1225339690 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARY M ZINKIN DPM, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4997 | ||||||||
| Address2: | |||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334424997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544268833 | ||||||||
| FaxNumber: | 9544269975 | ||||||||
| Practice Location | |||||||||
| Address1: | 1979 W HILLSBORO BLVD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334421444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544268833 | ||||||||
| FaxNumber: | 9544269975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2010 | ||||||||
| LastUpdateDate: | 12/12/2013 | ||||||||
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| AuthorizedOfficialLastName: | ZINKIN | ||||||||
| AuthorizedOfficialFirstName: | CARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9544268833 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | PO 1849 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 052082900 | 05 | FL | MEDICAID |