National Provider Identifier
Podiatry Affiliate Of Rochester PLLC
Podiatry Affiliate Of Rochester PLLC is listed in the NPPES registry with a primary specialty of Foot & Ankle Surgery Podiatrist in Rochester, NY and a listed phone number of (585) 642-6100.
Profile Overview
- NPI
- 1710490263
- Provider Type
- Organization
- Primary Specialty
- Foot & Ankle Surgery Podiatrist
- Enumeration Date
- November 07, 2017
- Last Updated
- March 14, 2022
Practice Location
- 1500 Portland Avenue
- Podiatry/Medical Suite
- Rochester, NY 14621-3065
Phone: (585) 642-6100
Mailing Address
- 1500 Portland Avenue
- Podiatry Suite
- Rochester, NY 14621-3065
Specialties
- Foot & Ankle Surgery Podiatrist (213ES0103X)
Full Record
- NPI
- 1710490263
- Entity Type
- Organization
- EIN
- <UNAVAIL>
- Organization Name
- Podiatry Affiliate Of Rochester PLLC
- Mailing Street Address
- 1500 Portland Avenue
- Mailing Address Line 2
- Podiatry Suite
- Mailing City
- Rochester
- Mailing State
- NY
- Mailing ZIP Code
- 14621-3065
- Mailing Country
- US
- Mailing Phone
- (585) 642-6100
- Mailing Fax
- (585) 642-6111
- Practice Street Address
- 1500 Portland Avenue
- Practice Address Line 2
- Podiatry/Medical Suite
- Practice City
- Rochester
- Practice State
- NY
- Practice ZIP Code
- 14621-3065
- Practice Country
- US
- Practice Phone
- (585) 642-6100
- Practice Fax
- (585) 642-6111
- Enumeration Date
- November 07, 2017
- Last Updated
- March 14, 2022
- Authorized Official Last Name
- Ellie
- Authorized Official First Name
- John
- Authorized Official Title
- CEO/President
- Authorized Official Phone
- (585) 642-6100
- Organization Subpart
- No
- Authorized Official Name Prefix Text
- Dr.
- Authorized Official Name Suffix Text
- Jr.
- Authorized Official Credential Text
- DPM
- Taxonomy Group 1
- 193400000X Single Specialty Group
- Certification Date
- March 01, 2022
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Foot & Ankle Surgery Podiatrist (213ES0103X)
- Other Identifiers
- 05448155 (NY)