| |
224 Harrison St., Suite 218, Sycracuse, NY 13202-3056 | |
(315) 295-0467 | |
(315) 295-1096 |
Full Name | |
---|---|
Type | Facility |
Speciality | Podiatrist |
Location | 224 Harrison St., Sycracuse, New York |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1356634414 | NPI | - | NPPES |
03158418 | Medicaid | NY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
213E00000X | Podiatrist | 006416 (New York) | Primary |
Mailing Address | Practice Location Address |
---|---|
1200 Kirts Blvd, Suite 200, Troy, MI 48084-4899 Ph: (248) 528-1981 | 224 Harrison St., Suite 218, Sycracuse, NY 13202-3056 Ph: (315) 295-0467 |