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General NPI Number Information
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NPI Number | 1831439660
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Entity Type | Organization
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Legal Business Name | SOUTHERN TIER PODIATRY PLLC
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Dates
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Enumeration Date | 02/14/2013
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Last Update Date | 07/02/2013
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Provider Practice Location Address
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Address Line | 4104 OLD VESTAL RD SUITE 104
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City | VESTAL
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State | NY
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Zip | 13850-3500
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Country | US
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Telephone | 607-217-5668
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Fax | 607-821-0255
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Provider Business Mailing Address
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Address Line | 4104 OLD VESTAL RD SUITE 104
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City | VESTAL
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State | NY
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Zip | 13850-3500
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Country | US
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Telephone | 607-217-5668
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Fax | 607-821-0255
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARILYN S BOYUKA
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Credential | D.P.M
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Telephone | 607-217-5668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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