MEDICARE: WESTSIDE PODIATRY GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0131X	Foot Surgery Podiatrist

General Provider Information

NPI Number	:	1427108992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTSIDE PODIATRY GROUP LLC

Provider Business Mailing Address
First Line	:	2236 W RIDGE RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-2804
Country	:	US
Telephone Number	:	585-225-2290
Fax Number	:	585-225-1367

Provider Business Practice Location Address
First Line	:	103 CANAL LANDING BLVD STE 12
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-5108
Country	:	US
Telephone Number	:	585-225-2290
Fax Number	:	585-225-1367

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	BRENDA MANGIONE
Credential	:
Telephone Number	:	585-225-9452

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	06/08/2026

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