Provider Demographics
NPI:1497006969
Name:FAMILY FOOT CARE OF ROCHESTER PC
Entity Type:Organization
Organization Name:FAMILY FOOT CARE OF ROCHESTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:PEEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:585-244-1150
Mailing Address - Street 1:4418 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:NY
Mailing Address - Zip Code:14589-9306
Mailing Address - Country:US
Mailing Address - Phone:315-589-9959
Mailing Address - Fax:315-589-5280
Practice Address - Street 1:4418 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:NY
Practice Address - Zip Code:14589-9306
Practice Address - Country:US
Practice Address - Phone:315-589-9959
Practice Address - Fax:315-589-5280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003177213ES0131X
NYN005134213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU49935Medicare UPIN
NYT26173Medicare UPIN