Provider Demographics
NPI:1275781460
Name:DR. MICHAEL WOOSTER, DPM PC
Entity Type:Organization
Organization Name:DR. MICHAEL WOOSTER, DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:WOOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-420-1832
Mailing Address - Street 1:826 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-4152
Mailing Address - Country:US
Mailing Address - Phone:516-420-1832
Mailing Address - Fax:
Practice Address - Street 1:826 MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-4152
Practice Address - Country:US
Practice Address - Phone:516-420-1832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004520213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6473070001OtherMEDICARE DMERC PTAN
NY01176594Medicaid
NY4769940001Medicare NSC
NYT72909Medicare UPIN
NYWPZ342Medicare PIN