Provider Demographics
NPI:1457317406
Name:FINKELSTEIN, MARK SIMON (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:SIMON
Last Name:FINKELSTEIN
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 1:67 GOLDEN PHEASANT DR
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1462
Mailing Address - Country:US
Mailing Address - Phone:716-689-2120
Mailing Address - Fax:
Practice Address - Street 1:1540 ELLICOTT CREEK RD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-2934
Practice Address - Country:US
Practice Address - Phone:716-695-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003920-0213E00000X, 213EP1101X, 213ER0200X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00942681Medicaid
NY00010253401OtherUNIVERA
NY8903881OtherINDEPENDANT HEALTH
NM000500898001OtherHEALTH NOW
NYT25944Medicare UPIN
NY0614230001Medicare NSC
NY00942681Medicaid