Provider Demographics
NPI:1972778918
Name:MOHAWK VALLEY PODIATRY, PC
Entity Type:Organization
Organization Name:MOHAWK VALLEY PODIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:DICAPRIO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:518-370-4331
Mailing Address - Street 1:1462 ERIE BLVD STE A202
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-1026
Mailing Address - Country:US
Mailing Address - Phone:518-370-4331
Mailing Address - Fax:518-372-9256
Practice Address - Street 1:1462 ERIE BLVD STE A202
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-1026
Practice Address - Country:US
Practice Address - Phone:518-370-4331
Practice Address - Fax:518-372-9256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004755213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1139Medicare PIN