Provider Demographics
NPI:1568635746
Name:MID HUDSON PODIATRY, PLLC
Entity Type:Organization
Organization Name:MID HUDSON PODIATRY, PLLC
Other - Org Name:ANDREW S. WILANTEWICZ, DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PODIATRIC PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILANTEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:845-462-8637
Mailing Address - Street 1:282 NEW HACKENSACK RD
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-1402
Mailing Address - Country:US
Mailing Address - Phone:845-462-8637
Mailing Address - Fax:845-462-1140
Practice Address - Street 1:282 NEW HACKENSACK RD
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-1402
Practice Address - Country:US
Practice Address - Phone:845-462-8637
Practice Address - Fax:845-462-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005494261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02062119Medicaid
NYPB5471Medicare PIN
NYU79350Medicare UPIN
NY4227600001Medicare NSC