Provider Demographics
NPI:1417611039
Name:FINGERLAKES ORTHOPEDIC AND SPINE, PLLC
Entity Type:Organization
Organization Name:FINGERLAKES ORTHOPEDIC AND SPINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIBUIKEM
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:AKAMNONU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-210-1801
Mailing Address - Street 1:3687 SUMMIT VW
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-2732
Mailing Address - Country:US
Mailing Address - Phone:310-210-1801
Mailing Address - Fax:
Practice Address - Street 1:2375 STATE ROUTE 332 STE 300
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-7512
Practice Address - Country:US
Practice Address - Phone:310-210-1801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-29
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty