Provider Demographics
NPI:1235167230
Name:TUBIOLO, ANDREW JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOSEPH
Last Name:TUBIOLO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 HAWKES TRL
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-4213
Mailing Address - Country:US
Mailing Address - Phone:585-670-0683
Mailing Address - Fax:585-787-0293
Practice Address - Street 1:714 TITUS AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-3927
Practice Address - Country:US
Practice Address - Phone:585-288-4050
Practice Address - Fax:585-787-0293
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003297213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010003297OtherBLUE CHOICE EXCELLUS
NY00718676Medicaid
NY100102EQOtherPREFERRED CARE
NY00718676Medicaid
NY100102EQOtherPREFERRED CARE