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General NPI Number Information
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NPI Number | 1407909039
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Entity Type | Organization
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Legal Business Name | GREEN MOUNTAIN FAMILY PODIATRY PC
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 212 BROADWAY
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City | WHITEHALL
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State | NY
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Zip | 12887-1639
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Country | US
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Telephone | 518-499-9264
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Fax | 518-499-9247
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Provider Business Mailing Address
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Address Line | 212 BROADWAY
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City | WHITEHALL
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State | NY
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Zip | 12887-1639
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Country | US
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Telephone | 518-499-9264
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Fax | 518-499-9247
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Authorized Official
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Title or Position | OWNER-PRESIDENT
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Name | DR. JOSE GUILLERMO IRIZARRY
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Credential | D.P.M.
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Telephone | 518-499-9264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 003568
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License Number State | NY
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