Provider Demographics
NPI:1437336732
Name:ORCHARD PARK PODIATRY PLLC
Entity Type:Organization
Organization Name:ORCHARD PARK PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEVINCENTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:716-667-2601
Mailing Address - Street 1:3671 SOUTHWESTERN BLVD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1752
Mailing Address - Country:US
Mailing Address - Phone:716-667-2601
Mailing Address - Fax:716-667-0089
Practice Address - Street 1:3671 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE 213
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1752
Practice Address - Country:US
Practice Address - Phone:716-667-2601
Practice Address - Fax:716-667-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002646332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA1142Medicare PIN