Provider Demographics
NPI:1184144719
Name:OPESE, ALPHA (DPM)
Entity type:Individual
Prefix:
First Name:ALPHA
Middle Name:
Last Name:OPESE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446A GUY PARK AVE.
Mailing Address - Street 2:PODIATRY HEALTH CENTER
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-1005
Mailing Address - Country:US
Mailing Address - Phone:518-770-7880
Mailing Address - Fax:
Practice Address - Street 1:446A GUY PARK AVE.
Practice Address - Street 2:PODIATRY HEALTH CENTER
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-1005
Practice Address - Country:US
Practice Address - Phone:518-770-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-25
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007116213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery