Provider Demographics
NPI:1780910448
Name:BATAVIA PODIATRY ASSOC LLC
Entity type:Organization
Organization Name:BATAVIA PODIATRY ASSOC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/DME SUPPLIER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:K
Authorized Official - Last Name:DRYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:585-344-1677
Mailing Address - Street 1:203 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1680
Mailing Address - Country:US
Mailing Address - Phone:585-344-1677
Mailing Address - Fax:585-344-2105
Practice Address - Street 1:203 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1680
Practice Address - Country:US
Practice Address - Phone:585-344-1677
Practice Address - Fax:585-344-2105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies