Provider Demographics
NPI:1275623266
Name:ADVANCED PODIATRIC MEDICINE & SURGERY, P.C.
Entity Type:Organization
Organization Name:ADVANCED PODIATRIC MEDICINE & SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:DARMOCHWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:845-691-9388
Mailing Address - Street 1:3725 US HIGHWAY 9W
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-2041
Mailing Address - Country:US
Mailing Address - Phone:845-691-9388
Mailing Address - Fax:845-691-9068
Practice Address - Street 1:3725 US HIGHWAY 9W
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-2041
Practice Address - Country:US
Practice Address - Phone:845-691-9388
Practice Address - Fax:845-691-9068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005278-1213E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPCWB51OtherAARP
NYVANESSA DARMOCHWALOtherINDECS
NYPCWB51OtherFIRST UNITED AMERICAN LIF
NY01879643Medicaid
NY10035850OtherCDPHP
NYNY9999OtherMUTUAL OF OMAHA
NYP1034534OtherOXFORD
NY150605577OtherAMERICAN PROGRESSIVE
NY2C6599OtherHEALTHNET
NY9108OtherGHI
NYP10831OtherEMPIRE BLUE CROSS BLUE SH
NY989630OtherMVP
NYPCWB51OtherAARP
NY=========OtherUNITED HEALTH CARE
NY========= 006OtherCIGNA
NYP1034534OtherOXFORD
NY01879643Medicaid
NY=========OtherTRICARE
NYVANESSA DARMOCHWALOtherINDECS
NYP1034534OtherOXFORD