Provider Demographics
NPI:1588718555
Name:WESTSIDE PODIATRY CENTER, LLP
Entity type:Organization
Organization Name:WESTSIDE PODIATRY CENTER, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:315-857-0140
Mailing Address - Street 1:8280 WILLETT PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-1325
Mailing Address - Country:US
Mailing Address - Phone:315-857-0140
Mailing Address - Fax:315-857-0144
Practice Address - Street 1:5415 W GENESEE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2162
Practice Address - Country:US
Practice Address - Phone:315-701-3348
Practice Address - Fax:315-701-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003729213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02554983Medicaid
NYAA1632Medicare ID - Type Unspecified