Provider Demographics
NPI:1710970108
Name:FERRELLI, CYNTHIA S (DPM)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:S
Last Name:FERRELLI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 HARRIS HILL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7407
Mailing Address - Country:US
Mailing Address - Phone:716-631-1133
Mailing Address - Fax:716-631-3030
Practice Address - Street 1:330 HARRIS HILL RD
Practice Address - Street 2:SUITE B
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-7407
Practice Address - Country:US
Practice Address - Phone:716-631-1133
Practice Address - Fax:716-631-3030
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY0046741213E00000X
NYNY004674-1213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Not Answered213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
BC ROCHESTEROtherP01004674
MCR SHOE PROGRAMOther0996190001
P046749BOtherWORKERS COMP
00052799400OtherBC ORTHOTICS ETC
0892504OtherAETNA US HEALTHCARE
0004413215OtherAETNA EL PASO TX
NY01215118Medicaid
GHIOther6200202
NY5279945OtherCB ORTHOTIC PROVIDER #
00010252502OtherUNIVERA AND SENIOR CHOICE
P6348OtherEMPIRE BCBS
8990329OtherIHA
00010252502OtherUNIVERA AND SENIOR CHOICE
NY279943Medicare ID - Type Unspecified