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General NPI Number Information
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NPI Number | 1891393906
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Entity Type | Organization
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Legal Business Name | FINGER LAKES PODIATRY OF GENEVA, PLLC
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Dates
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Enumeration Date | 10/12/2020
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Last Update Date | 05/09/2022
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Provider Practice Location Address
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Address Line | 1331 E. VICTOR RD
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City | VICTOR
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State | NY
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Zip | 14564-9306
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Country | US
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Telephone | 585-742-3777
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Fax | 585-742-3785
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Provider Business Mailing Address
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Address Line | 650 PRE EMPTION RD
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City | GENEVA
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State | NY
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Zip | 14456-1334
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Country | US
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Telephone | 315-789-8132
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAWRENCE LARUSSA
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Credential | DPM
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Telephone | 315-789-8132
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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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