Provider Demographics
NPI:1124053640
Name:CENTEROCK PODIATRY ASSOCIATES, PC
Entity type:Organization
Organization Name:CENTEROCK PODIATRY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:845-358-2844
Mailing Address - Street 1:2 CROSFIELD AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2226
Mailing Address - Country:US
Mailing Address - Phone:845-358-2844
Mailing Address - Fax:845-358-0528
Practice Address - Street 1:2 CROSFIELD AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2226
Practice Address - Country:US
Practice Address - Phone:845-358-2844
Practice Address - Fax:845-358-0528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1057830001OtherDME
NJ096438Medicare PIN
NY1057830001OtherDME
NYP5W391Medicare PIN