Provider Demographics
NPI:1235325861
Name:MARIO G. SILVESTRI, DPM, PC
Entity Type:Organization
Organization Name:MARIO G. SILVESTRI, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:SILVESTRI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:607-484-3668
Mailing Address - Street 1:1003 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5221
Mailing Address - Country:US
Mailing Address - Phone:607-484-3668
Mailing Address - Fax:607-757-9375
Practice Address - Street 1:1003 MONROE ST
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5221
Practice Address - Country:US
Practice Address - Phone:607-484-3668
Practice Address - Fax:607-757-9375
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TIER FOOT CARE ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-18
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0043191213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
480007267OtherRR MCR
NY01045629Medicaid
56131AMedicare PIN
0862910001Medicare NSC
NY56131AMedicare Oscar/Certification