Provider Demographics
NPI:1053786574
Name:PODIATRY ASSOCIATES OF ROCHESTER, LLP
Entity type:Organization
Organization Name:PODIATRY ASSOCIATES OF ROCHESTER, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GIORDANO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:585-371-8600
Mailing Address - Street 1:1255 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-2713
Mailing Address - Country:US
Mailing Address - Phone:585-342-8700
Mailing Address - Fax:585-342-4159
Practice Address - Street 1:360 LINDEN OAKS
Practice Address - Street 2:SUITE 120
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2814
Practice Address - Country:US
Practice Address - Phone:585-371-8600
Practice Address - Fax:585-342-4159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03208335Medicaid
NY1386739514Medicare NSC