Provider Demographics
NPI:1528139466
Name:LAFFERTY, WILLIAM ANTHONY (DPM)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ANTHONY
Last Name:LAFFERTY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:250 PARKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2242
Mailing Address - Country:US
Mailing Address - Phone:718-351-0786
Mailing Address - Fax:718-351-3983
Practice Address - Street 1:175 GUYON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3947
Practice Address - Country:US
Practice Address - Phone:718-351-0786
Practice Address - Fax:718-351-3983
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005596213ES0103X
NJ25MD00259300213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1499659OtherGHI
NY7862397OtherAETNA
NYN0U231OtherBLUE CROSS PPO
NYP2650586OtherOXFORD
NYPG9311OtherBLUE CROSS HMO
NY2223930OtherUNITED HEALTHCARE
370013065OtherCHILD HEALTH PLUS
NY7862397OtherAETNA
NY2223930OtherUNITED HEALTHCARE