Provider Demographics
NPI:1356001457
Name:UPSTATE FOOT AND ANKLE PA
Entity Type:Organization
Organization Name:UPSTATE FOOT AND ANKLE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PUTRINO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:607-222-6633
Mailing Address - Street 1:2656 LAGUNA DR
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-7217
Mailing Address - Country:US
Mailing Address - Phone:607-222-6633
Mailing Address - Fax:
Practice Address - Street 1:5 WINCHESTER CT
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2626
Practice Address - Country:US
Practice Address - Phone:607-222-6633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty