Healthcare Provider Details

I. General information

NPI: 1427155993
Provider Name (Legal Business Name): HEALTHDRIVE PODIATRY GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 WORCESTER ST SUITE 130
WELLESLEY MA
02482-3744
US

IV. Provider business mailing address

888 WORCESTER ST SUITE 130
WELLESLEY MA
02482-3744
US

V. Phone/Fax

Practice location:
  • Phone: 617-964-6681
  • Fax: 339-686-2561
Mailing address:
  • Phone: 617-964-6681
  • Fax: 339-686-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. RIYA ALTOMONTE
Title or Position: PRESIDENT/PRACTICE DIRECTOR
Credential: DPM
Phone: 857-255-0486