Provider Demographics
NPI:1588782635
Name:PODIATRY SOLUTIONS OF WNY PLLC
Entity type:Organization
Organization Name:PODIATRY SOLUTIONS OF WNY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:716-634-5993
Mailing Address - Street 1:15 S FOREST RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6425
Mailing Address - Country:US
Mailing Address - Phone:716-634-5993
Mailing Address - Fax:716-650-4082
Practice Address - Street 1:15 S FOREST RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6425
Practice Address - Country:US
Practice Address - Phone:716-634-5993
Practice Address - Fax:716-650-4082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005864213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026080003OtherUNIVERA
NY00526926002OtherBC WNY
NY02344012Medicaid
NY00526926002OtherBC WNY
NYBA1032Medicare PIN
NY02344012Medicaid