Provider Demographics
NPI:1578672366
Name:FOOT SPECIALIST ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:FOOT SPECIALIST ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:518-869-5799
Mailing Address - Street 1:1692 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-4045
Mailing Address - Country:US
Mailing Address - Phone:518-869-5799
Mailing Address - Fax:518-862-1489
Practice Address - Street 1:1692 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-4045
Practice Address - Country:US
Practice Address - Phone:518-869-5799
Practice Address - Fax:518-862-1489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000405556002OtherSENIOR BLUE
NY00040556002OtherBLUE SHIELD OF NENY
NYP32002OtherBC/BS
NY113722OtherWELLCARE
NY6202091OtherGHI
NYC14565OtherRAILROAD MEDICARE
NY00040556002OtherBLUE SHIELD OF NENY
NY1304120002Medicare NSC