Healthcare Provider Details

I. General information

NPI: 1275623266
Provider Name (Legal Business Name): ADVANCED PODIATRIC MEDICINE & SURGERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 US HIGHWAY 9W
HIGHLAND NY
12528-2041
US

IV. Provider business mailing address

3725 US HIGHWAY 9W
HIGHLAND NY
12528-2041
US

V. Phone/Fax

Practice location:
  • Phone: 845-691-9388
  • Fax: 845-691-9068
Mailing address:
  • Phone: 845-691-9388
  • Fax: 845-691-9068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN005278-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. VANESSA MARY DARMOCHWAL
Title or Position: PRESIDENT
Credential: D.P.M
Phone: 845-691-9388