Provider Demographics
NPI:1922046366
Name:NEW CENTURY PODIATRY, PC
Entity Type:Organization
Organization Name:NEW CENTURY PODIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:PELLETIER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:315-785-3668
Mailing Address - Street 1:21017 NYS RTE 12F
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4999
Mailing Address - Country:US
Mailing Address - Phone:315-785-3668
Mailing Address - Fax:315-779-2090
Practice Address - Street 1:21017 NYS RTE 12F
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4999
Practice Address - Country:US
Practice Address - Phone:315-785-3668
Practice Address - Fax:315-779-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA0664Medicare PIN
0840250001Medicare NSC