Provider Demographics
NPI:1629158902
Name:ADVANCED PODIATRY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:ADVANCED PODIATRY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:MONCKTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-343-8150
Mailing Address - Street 1:2 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-2132
Mailing Address - Country:US
Mailing Address - Phone:585-343-8150
Mailing Address - Fax:585-343-1768
Practice Address - Street 1:2 STATE ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2132
Practice Address - Country:US
Practice Address - Phone:585-343-8150
Practice Address - Fax:585-343-1768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004862213ES0103X
NY006113213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG0186947190OtherEXCELLUS BC GROUP NUMBER
NY5507080001OtherDMERC
NYG0186947190OtherEXCELLUS BC GROUP NUMBER