Healthcare Provider Details

I. General information

NPI: 1356806905
Provider Name (Legal Business Name): ANKLE AND FOOT CENTERS OF WESTERN NEW YORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 08/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8745 LAKE STREET RD
LE ROY NY
14482-9344
US

IV. Provider business mailing address

45 SUMMIT ST
LE ROY NY
14482-1530
US

V. Phone/Fax

Practice location:
  • Phone: 585-297-9761
  • Fax: 585-672-9100
Mailing address:
  • Phone: 585-797-5828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: GEORGE VITO
Title or Position: FOOT AND ANKLE SURGEON
Credential: DPM
Phone: 585-297-9761