Healthcare Provider Details

I. General information

NPI: 1558455477
Provider Name (Legal Business Name): CAPITAL FOOT SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 CURRY RD
ROTTERDAM NY
12306-3707
US

IV. Provider business mailing address

1217 CURRY RD
ROTTERDAM NY
12306-3707
US

V. Phone/Fax

Practice location:
  • Phone: 518-785-1110
  • Fax:
Mailing address:
  • Phone: 518-785-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MARY BRIGHID LODGE
Title or Position: DPM
Credential: DPM
Phone: 518-785-1110