Healthcare Provider Details

I. General information

NPI: 1003995275
Provider Name (Legal Business Name): NATHAN DELROY ASHBY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 SOUTHWOOD HEIGHTS DRIVE NATHAN ASHBY DPM PLLC-IROQUOIS NURSING HOME
JAMESVILLE NY
13078
US

IV. Provider business mailing address

124 MARGO LANE NATHAN ASHBY DPM PLLC
FAYETTEVILLE NY
13066
US

V. Phone/Fax

Practice location:
  • Phone: 315-308-3163
  • Fax:
Mailing address:
  • Phone: 315-308-3163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN005863-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: