NPIMap

Organization Active NPI

Podiatry Services of Central New York, PC

  • Foot & Ankle Surgery Podiatrist
  • Fayetteville, NY
National Provider Identifier
1477201176
Registry record updated Mar 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
PODIATRY SERVICES OF CENTRAL NEW YORK, PC
Practice address
6900 Highbridge Road
Fayetteville, NY 13066
Phone
(315) 299-5007
NPI assigned
Mar 13, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2022

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

Authorized official

Name
Dr. Freddie L. Edelman, DPMNPI 1508843855
Title
Owner
Phone
(315) 458-1777

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X Primary

Addresses

Primary practice location

6900 Highbridge Road
Fayetteville, NY 13066

Mailing address

514 S. Bay Road
North Syracuse, NY 13212-3627
Phone (315) 458-1777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221006000786 NY DME Supplier - Physician - General Practice 2062468895 Practice locations: Fayetteville, NY

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Podiatry Services of C13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

171 Grant Ave
Auburn, NY 13021
Phone (315) 255-0070

2187 County Route 12
Central Square, NY 13036
Phone (315) 668-9532

206 Tuscarora Rd
Chittenango, NY 13037
Phone (315) 687-9400

6647 Kirkville Rd
East Syracuse, NY 13057
Phone (315) 433-0090

151 N 2nd St
Ste B
Fulton, NY 13069
Phone (315) 593-1134

441 S Salina St
Fl 2
Syracuse, NY 13202
Phone (315) 422-1870

4671 Onondaga Blvd
Ste A700
Syracuse, NY 13219
Phone (315) 422-1870

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1647129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647129600000",
    "number": "1477201176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 S. BAY ROAD",
            "city": "NORTH SYRACUSE",
            "state": "NY",
            "postal_code": "132123627",
            "telephone_number": "315-458-1777",
            "fax_number": "315-458-9661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 HIGHBRIDGE ROAD",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "13066",
            "telephone_number": "315-299-5007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PODIATRY SERVICES OF CENTRAL NEW YORK, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-13",
        "last_updated": "2022-03-13",
        "certification_date": "2022-03-13",
        "status": "A",
        "authorized_official_last_name": "EDELMAN",
        "authorized_official_first_name": "FREDDIE",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-458-1777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.