Provider Demographics
NPI:1497958730
Name:REALE, GUY ANTHONY (DPM)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:ANTHONY
Last Name:REALE
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 1:920 WINTON ROAD SOUTH
Mailing Address - Street 2:BRIGHTON MEDICAL CENTER
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-1634
Mailing Address - Country:US
Mailing Address - Phone:585-442-1910
Mailing Address - Fax:
Practice Address - Street 1:920 WINTON ROAD SOUTH
Practice Address - Street 2:BRIGHTON MEDICAL CENTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-1634
Practice Address - Country:US
Practice Address - Phone:585-442-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03429213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00812611Medicaid
NY00812611Medicaid
T89431Medicare UPIN