| NPI | 1467151852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE CONWAY-RUSSELL Provider Enrollment Specialist 315-253-1838 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery |
| Enumeration Date | 2023-02-24 |
| Last Update Date | 2023-02-24 |