Healthcare Provider Details

I. General information

NPI: 1427108992
Provider Name (Legal Business Name): WESTSIDE PODIATRY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2236 RIDGE RD W
ROCHESTER NY
14626-2804
US

IV. Provider business mailing address

2236 RIDGE RD W
ROCHESTER NY
14626-2804
US

V. Phone/Fax

Practice location:
  • Phone: 585-225-2290
  • Fax: 585-225-1367
Mailing address:
  • Phone: 585-225-2290
  • Fax: 585-225-1367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MR. KAREN JEAN PUTNAM
Title or Position: FINANCIAL MANAGER
Credential:
Phone: 585-225-2290