Provider Demographics
NPI:1720058522
Name:WOOSTER, MICHAEL F (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
Last Name:WOOSTER
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 1:700-6 PATCHOGUE YAPHANK RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763
Mailing Address - Country:US
Mailing Address - Phone:631-345-5280
Mailing Address - Fax:631-775-1429
Practice Address - Street 1:700-6 PATCHOGUE YAPHANK RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763
Practice Address - Country:US
Practice Address - Phone:631-345-5280
Practice Address - Fax:631-775-1429
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004520213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T72909Medicare UPIN
NY4769940001Medicare NSC
NYP50171Medicare ID - Type Unspecified