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General NPI Number Information
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NPI Number | 1699178962
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Entity Type | Organization
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Legal Business Name | PODIATRY SERVICES PLLC
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Dates
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Enumeration Date | 10/01/2014
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Last Update Date | 10/01/2014
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Provider Practice Location Address
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Address Line | 175 ROUTE 304
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City | BARDONIA
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State | NY
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Zip | 10954-2042
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Country | US
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Telephone | 845-215-9800
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Fax | 845-215-9803
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Provider Business Mailing Address
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Address Line | 175 ROUTE 304
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City | BARDONIA
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State | NY
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Zip | 10954-2042
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Country | US
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Telephone | 845-215-9800
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Fax | 845-215-9803
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | THERESA GIACOBBE
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Credential |
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Telephone | 845-215-9800
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 006498
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License Number State | NY
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