MEDICARE: DR. MICHAEL F WOOSTER DPM

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	213E00000X	Podiatrist	N004520	NY

General Provider Information

NPI Number	:	1720058522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL F WOOSTER DPM

Provider Business Mailing Address
First Line	:	700-6 PATCHOGUE YAPHANK RD
Second Line	:
City	:	MEDFORD
State	:	NY
Zip	:	11763
Country	:	US
Telephone Number	:	631-345-5280
Fax Number	:	631-775-1429

Provider Business Practice Location Address
First Line	:	700-6 PATCHOGUE YAPHANK RD
Second Line	:
City	:	MEDFORD
State	:	NY
Zip	:	11763
Country	:	US
Telephone Number	:	631-345-5280
Fax Number	:	631-775-1429

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	08/03/2012

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