Provider Demographics
NPI:1437292406
Name:FARRELL, MICHAEL D (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:FARRELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 436
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NY
Mailing Address - Zip Code:13838-0436
Mailing Address - Country:US
Mailing Address - Phone:607-563-8167
Mailing Address - Fax:
Practice Address - Street 1:44 PEARL ST W
Practice Address - Street 2:GELDER MEDICAL BUILDING
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-1325
Practice Address - Country:US
Practice Address - Phone:607-563-8167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004551213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1871777441OtherMEDICARE DME
NY5664640001Medicare NSC
NYP50571Medicare ID - Type UnspecifiedPODIATRY
NY1871777441OtherMEDICARE DME
NY1437292406Medicare NSC
NYT92840Medicare UPIN