Provider Demographics
NPI:1891393906
Name:FINGER LAKES PODIATRY OF GENEVA, PLLC
Entity Type:Organization
Organization Name:FINGER LAKES PODIATRY OF GENEVA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LARUSSA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:315-789-8132
Mailing Address - Street 1:650 PRE EMPTION RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1334
Mailing Address - Country:US
Mailing Address - Phone:315-789-8132
Mailing Address - Fax:
Practice Address - Street 1:1331 E. VICTOR RD
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9306
Practice Address - Country:US
Practice Address - Phone:585-742-3777
Practice Address - Fax:585-742-3785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty