Provider Demographics
NPI:1205054442
Name:PODIATRY SOLUTIONS OF WNY
Entity type:Organization
Organization Name:PODIATRY SOLUTIONS OF WNY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:T
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:716-434-6601
Mailing Address - Street 1:15 S FOREST RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6444
Mailing Address - Country:US
Mailing Address - Phone:716-634-5993
Mailing Address - Fax:716-478-0946
Practice Address - Street 1:15 S FOREST RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6444
Practice Address - Country:US
Practice Address - Phone:716-634-5993
Practice Address - Fax:716-478-0946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
305S00000X
NY005864213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000526926002OtherBLUE CROSS
NY00026080003OtherUNIVERA
NY000526926002OtherBLUE CROSS
NYU91710Medicare UPIN
NYRB2379Medicare PIN