Provider Demographics
NPI:1295712552
Name:BEABES, JUSTIN (DPM)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:BEABES
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 1:8132B OSWEGO RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1500
Mailing Address - Country:US
Mailing Address - Phone:315-546-0285
Mailing Address - Fax:315-546-0289
Practice Address - Street 1:8132B OSWEGO RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1500
Practice Address - Country:US
Practice Address - Phone:315-546-0285
Practice Address - Fax:315-546-0289
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006116213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02672879Medicaid
NY02672879Medicaid
NYRA7496Medicare PIN
NY0468700001Medicare NSC