MEDICARE: ROCHESTER PODIATRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	N005428	NY

General Provider Information

NPI Number	:	1184814733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCHESTER PODIATRY LLC

Provider Business Mailing Address
First Line	:	382 WHITE SPRUCE BLVD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-1604
Country	:	US
Telephone Number	:	585-424-2420
Fax Number	:	585-424-2422

Provider Business Practice Location Address
First Line	:	382 WHITE SPRUCE BLVD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-1604
Country	:	US
Telephone Number	:	585-424-2420
Fax Number	:	585-424-2422

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MASSIMO PIETRANTONI
Credential	:	D.P.M.
Telephone Number	:	585-424-2420

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	07/30/2007

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