Healthcare Provider Details

I. General information

NPI: 1407289077
Provider Name (Legal Business Name): UPSTATE PODIATRY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2013
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NOTT ST STE 303
SCHENECTADY NY
12308-2589
US

IV. Provider business mailing address

1201 NOTT ST STE 303
SCHENECTADY NY
12308-2589
US

V. Phone/Fax

Practice location:
  • Phone: 518-357-3152
  • Fax:
Mailing address:
  • Phone: 518-357-3152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number005216
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number005216
License Number StateNY

VIII. Authorized Official

Name: SCOTT JAMES PICKETT
Title or Position: CEO
Credential: DPM
Phone: 518-573-9180