Provider Demographics
NPI:1346338290
Name:THE FOOT DOCTOR, P.C.
Entity Type:Organization
Organization Name:THE FOOT DOCTOR, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:GMEREK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:585-226-9340
Mailing Address - Street 1:1655 ELMWOOD AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3429
Mailing Address - Country:US
Mailing Address - Phone:585-226-9340
Mailing Address - Fax:585-235-1051
Practice Address - Street 1:102 GENESEE ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:NY
Practice Address - Zip Code:14414-1222
Practice Address - Country:US
Practice Address - Phone:585-226-9340
Practice Address - Fax:585-235-1051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005586213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG0184705620OtherFINGER LAKES
NYG0184705620OtherBLUE CHOICE
NY02146569Medicaid
NYP00074369OtherMEDICARE RAILROAD
NY000924073002OtherBC/BS WESTERN NY
NYMDH352OtherPREFERRED CARE
NYMDH352OtherPREFERRED CARE
NYAA1462/DD3997Medicare ID - Type Unspecified
NY5008670001Medicare NSC