Michael J Pietrusik, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

NOO36341 Issued in NY

Practice address

3277 South Park Avenue
Lackawanna, NY 14218-3527

Phone

(716) 822-3411

Fax

(716) 822-0215

NPI assigned

Jul 17, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Kent State University College of Podiatric Medicine, 1983

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Hospital & facility affiliations

• Brooks-TLC Hospital System, Inc Hospital, Dunkirk, NY, CCN 330229

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Brooks - TLC Hospital System Inc

  • Family Medicine Physician
  • Gowanda, NY
  • NPI 1538419502

  Hospital

  Care Compare affiliation
• Brooks - TLC Hospital System, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Derby, NY
  • NPI 1225654494

  Hospital

  Care Compare affiliation
• Brooks - TLC Hospital System, Inc.

  • Urgent Care Clinic/Center
  • Gowanda, NY
  • NPI 1487738886

  Hospital

  Care Compare affiliation
• Brooks-TLC Hospital System, Inc.

  • General Acute Care Hospital
  • Dunkirk, NY
  • NPI 1215917224
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318550400000",
    "number": "1356368864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3277 SOUTH PARK AVENUE",
            "city": "LACKAWANNA",
            "state": "NY",
            "postal_code": "142183527",
            "telephone_number": "716-822-3411",
            "fax_number": "716-822-0215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3277 SOUTH PARK AVENUE",
            "city": "LACKAWANNA",
            "state": "NY",
            "postal_code": "142183527",
            "telephone_number": "716-822-3411",
            "fax_number": "716-822-0215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PIETRUSIK",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2011-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NY",
            "license": "NOO36341",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00845978",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aylwyn Jean Pelletreau
• Howard A. Penn, DPM
• Diana Petruzzella, LBA
• Suzanne M Picinich, DO
• Cheryl Pieczonka, LCSW
• Luiza Podlesny, PT, MPT
• Deanna C Polito, SLP
• Chanel Marie Poole, LMT
• Lori Potteiger
• Jennifer L Povinelli, MSED

• Podiatrist in Lackawanna, NY
• Providers in Lackawanna, NY by specialty
• Podiatrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.