Provider Demographics
NPI:1275783862
Name:COMPLETE FOOT CARE OF THE FINGER LAKES, PLLC
Entity Type:Organization
Organization Name:COMPLETE FOOT CARE OF THE FINGER LAKES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:Z
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:315-331-5059
Mailing Address - Street 1:165 WEST SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1050
Mailing Address - Country:US
Mailing Address - Phone:315-331-5059
Mailing Address - Fax:315-331-5482
Practice Address - Street 1:165 WEST SHORE BLVD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1050
Practice Address - Country:US
Practice Address - Phone:315-331-5059
Practice Address - Fax:315-331-5482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO5548213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY106106EQOtherPREFERRED CARE
NY01955462Medicaid
NY106106EQOtherPREFERRED CARE