Provider Demographics
NPI:1275564882
Name:BATAVIA PODIATRY ASSOCIATES LLC
Entity Type:Organization
Organization Name:BATAVIA PODIATRY ASSOCIATES LLC
Other - Org Name:BATAVIA FOOT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:K
Authorized Official - Last Name:DRYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:585-344-1677
Mailing Address - Street 1:3922 W MAIN STREET RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-9467
Mailing Address - Country:US
Mailing Address - Phone:585-344-1677
Mailing Address - Fax:585-344-2105
Practice Address - Street 1:3922 W MAIN STREET RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-9467
Practice Address - Country:US
Practice Address - Phone:585-344-1677
Practice Address - Fax:585-344-2105
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BATAVIA PODIATRY ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-05
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4375000001Medicare NSC
NYCC9210Medicare PIN
NYCC9211Medicare PIN