Provider Demographics
NPI:1356634414
Name:ONHEALTHCARE OPTOMETRY AND PODIATRY, PLLC
Entity type:Organization
Organization Name:ONHEALTHCARE OPTOMETRY AND PODIATRY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIAIMO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-528-1981
Mailing Address - Street 1:1200 KIRTS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4899
Mailing Address - Country:US
Mailing Address - Phone:248-528-1981
Mailing Address - Fax:248-528-2963
Practice Address - Street 1:224 HARRISON ST.
Practice Address - Street 2:SUITE 218
Practice Address - City:SYCRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3056
Practice Address - Country:US
Practice Address - Phone:315-295-0467
Practice Address - Fax:315-295-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006416213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03158418Medicaid
NYJ100008791Medicare UPIN