Provider Demographics
NPI:1063699338
Name:ROBERT L. GILFERT, DPM
Entity type:Organization
Organization Name:ROBERT L. GILFERT, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:GILFERT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:585-593-3900
Mailing Address - Street 1:4305 FASSETT LN
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-9327
Mailing Address - Country:US
Mailing Address - Phone:585-593-3900
Mailing Address - Fax:585-593-3901
Practice Address - Street 1:4305 FASSETT LN
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-9327
Practice Address - Country:US
Practice Address - Phone:585-593-3900
Practice Address - Fax:585-593-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004553-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01159604Medicaid
NY256561Medicare PIN
NYU02392Medicare UPIN
0316540001Medicare NSC