Healthcare Provider Details

I. General information

NPI: 1346338290
Provider Name (Legal Business Name): THE FOOT DOCTOR, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 GENESEE ST
AVON NY
14414-1222
US

IV. Provider business mailing address

1655 ELMWOOD AVE SUITE 205
ROCHESTER NY
14620-3429
US

V. Phone/Fax

Practice location:
  • Phone: 585-226-9340
  • Fax: 585-235-1051
Mailing address:
  • Phone: 585-226-9340
  • Fax: 585-235-1051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN005586
License Number StateNY

VIII. Authorized Official

Name: DR. RONALD S GMEREK
Title or Position: PODIATRIST/ OWNER
Credential: DPM
Phone: 585-226-9340