Provider Demographics
NPI:1225211014
Name:FOOT DOCTORS OF UTICA, P.C.
Entity Type:Organization
Organization Name:FOOT DOCTORS OF UTICA, P.C.
Other - Org Name:DANIEL HERBOWY, DPM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:HERBOWY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:315-793-3668
Mailing Address - Street 1:6 BUSINESS PARK CT
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6309
Mailing Address - Country:US
Mailing Address - Phone:315-793-3668
Mailing Address - Fax:315-793-3691
Practice Address - Street 1:6 BUSINESS PARK CT
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6309
Practice Address - Country:US
Practice Address - Phone:315-793-3668
Practice Address - Fax:315-793-3691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03046682Medicaid
NY6187680002Medicare NSC
NY03046682Medicaid