Provider Demographics
NPI:1972254522
Name:WESTCHESTER PODIATRIC SURGICAL, PC
Entity Type:Organization
Organization Name:WESTCHESTER PODIATRIC SURGICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DELUCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:866-332-7691
Mailing Address - Street 1:465 COLUMBUS AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1376
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:465 COLUMBUS AVE STE 140
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1376
Practice Address - Country:US
Practice Address - Phone:866-332-7691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty