Provider Demographics
NPI:1033386206
Name:BRYAN G. POPOVICI, DPM, PC
Entity Type:Organization
Organization Name:BRYAN G. POPOVICI, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:POPOVICI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:315-451-8256
Mailing Address - Street 1:7304 OSWEGO ROAD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:N.Y.
Mailing Address - Zip Code:13090
Mailing Address - Country:UM
Mailing Address - Phone:315-451-8256
Mailing Address - Fax:315-451-2335
Practice Address - Street 1:7304 OSWEGO RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-3718
Practice Address - Country:US
Practice Address - Phone:315-451-8256
Practice Address - Fax:315-451-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO3830213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00920594Medicaid
NY100007266502OtherAMERICHOICE/UNITED HEALTHCARE
5219121OtherAETNA
6813OtherTOTAL CARE
480005715OtherTRAVELERS MEDICARE
040426015156OtherFIDELIS
NY0061216OtherGHI
57106OtherHEALTHNET
NY1037130001Medicare NSC
5219121OtherAETNA
NYT26617Medicare UPIN