Healthcare Provider Details

I. General information

NPI: 1184814733
Provider Name (Legal Business Name): ROCHESTER PODIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 WHITE SPRUCE BLVD
ROCHESTER NY
14623-1604
US

IV. Provider business mailing address

382 WHITE SPRUCE BLVD
ROCHESTER NY
14623-1604
US

V. Phone/Fax

Practice location:
  • Phone: 585-424-2420
  • Fax: 585-424-2422
Mailing address:
  • Phone: 585-424-2420
  • Fax: 585-424-2422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN005428
License Number StateNY

VIII. Authorized Official

Name: DR. MASSIMO PIETRANTONI
Title or Position: OWNER
Credential: D.P.M.
Phone: 585-424-2420