Provider Demographics
NPI:1215050463
Name:PODIATRY SOLUTIONS OF WNY PLLC
Entity type:Organization
Organization Name:PODIATRY SOLUTIONS OF WNY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:T
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:716-434-6601
Mailing Address - Street 1:6000 BROCKTON DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-9273
Mailing Address - Country:US
Mailing Address - Phone:716-434-6601
Mailing Address - Fax:716-434-1096
Practice Address - Street 1:6000 BROCKTON DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-9273
Practice Address - Country:US
Practice Address - Phone:716-434-6601
Practice Address - Fax:716-434-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005864213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0052696002OtherBLUE CROSS
NY02344012Medicaid
NY0026080003OtherUNIVERA
NYRB2379Medicare PIN
NYBA1032Medicare PIN
NY02344012Medicaid