Provider Demographics
NPI:1831158435
Name:CARREL, JEFFREY M (DPM)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:CARREL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:JEFFREY
Other - Middle Name:M
Other - Last Name:CARREL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:6255 SHERIDAN DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4836
Mailing Address - Country:US
Mailing Address - Phone:716-857-8666
Mailing Address - Fax:716-630-1054
Practice Address - Street 1:6325 MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5822
Practice Address - Country:US
Practice Address - Phone:716-630-1295
Practice Address - Fax:716-250-5999
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYN002175213E00000X
NY002175213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00588610Medicaid
NY034663OtherPTAN
T25879Medicare UPIN