=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609340900
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOOT AND ANKLE SOCIETY OF NEW YORK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2019
-----------------------------------------------------
Last Update Date | 01/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45 SUMMIT ST
-----------------------------------------------------
City | LE ROY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14482-1530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-797-5828
-----------------------------------------------------
Fax | 585-672-9100
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 SUMMIT ST
-----------------------------------------------------
City | LE ROY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14482-1530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-797-5828
-----------------------------------------------------
Fax | 585-672-9100
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ANKLE AND FOOT SURGEON
-----------------------------------------------------
Name | DR. GEORGE VITO
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 585-797-5828
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------