Provider Demographics
NPI:1427108992
Name:WESTSIDE PODIATRY GROUP LLC
Entity type:Organization
Organization Name:WESTSIDE PODIATRY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PUTNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-225-2290
Mailing Address - Street 1:2236 RIDGE RD W
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2804
Mailing Address - Country:US
Mailing Address - Phone:585-225-2290
Mailing Address - Fax:585-225-1367
Practice Address - Street 1:2236 RIDGE RD W
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2804
Practice Address - Country:US
Practice Address - Phone:585-225-2290
Practice Address - Fax:585-225-1367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0503470003Medicare NSC
16336AMedicare ID - Type Unspecified