Provider Demographics
NPI:1881733939
Name:VICKI J. MILLER-SAVARD & CARRIE Z. O'NEILL
Entity type:Organization
Organization Name:VICKI J. MILLER-SAVARD & CARRIE Z. O'NEILL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:Z
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:315-331-5059
Mailing Address - Street 1:1000 DRIVING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1050
Mailing Address - Country:US
Mailing Address - Phone:315-331-5059
Mailing Address - Fax:315-331-5482
Practice Address - Street 1:1000 DRIVING PARK AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1050
Practice Address - Country:US
Practice Address - Phone:315-331-5059
Practice Address - Fax:315-331-5482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO5139213E00000X
335E00000X
NYNOO5548213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02554281Medicaid
NYG018583821OtherEXCELLUS BCBS
NYG018583821OtherEXCELLUS BCBS
NY02554281Medicaid