Provider Demographics
NPI:1912107244
Name:GLENN W. CALLAHAN, D.P.M.
Entity Type:Organization
Organization Name:GLENN W. CALLAHAN, D.P.M.
Other - Org Name:FOOT CARE CENTER OF YONKERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:914-423-8808
Mailing Address - Street 1:626 MCLEAN AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-4738
Mailing Address - Country:US
Mailing Address - Phone:914-423-8808
Mailing Address - Fax:914-423-8810
Practice Address - Street 1:626 MCLEAN AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-4738
Practice Address - Country:US
Practice Address - Phone:914-423-8808
Practice Address - Fax:914-423-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0038981332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009045723Medicaid
NYWS1077OtherOXFORD
NYP51252OtherEMPIRE BLUE CROSS BLUE SH
T51253Medicare UPIN
NYWS1077OtherOXFORD
NYP51252Medicare PIN