NPIMap

Organization Active NPI

Podiatry Services of Central New York, PC

  • Foot & Ankle Surgery Podiatrist
  • Syracuse, NY
National Provider Identifier
1801279732
Registry record updated Oct 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
N002777-1 Issued in NY
Legal business name
PODIATRY SERVICES OF CENTRAL NEW YORK, PC
Practice address
4623 Onondaga Blvd.
Syracuse, NY 13219
Phone
(315) 422-1870
Fax
(315) 422-7066
NPI assigned
Jul 9, 2015
Last updated
Oct 19, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2016

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 N002777-1 NY Primary

Addresses

Primary practice location

4623 Onondaga Blvd.
Syracuse, NY 13219

Mailing address

514 South Bay Road
North Syracuse, NY 13212-3626
Phone (315) 458-1777

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151009002397 NY DME Supplier - Physician - General Practice 2062468895 Practice locations: Auburn, 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 CN13 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.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1436400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476835200000",
    "number": "1801279732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 SOUTH BAY ROAD",
            "city": "NORTH SYRACUSE",
            "state": "NY",
            "postal_code": "132123626",
            "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": "4623 ONONDAGA BLVD.",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13219",
            "telephone_number": "315-422-1870",
            "fax_number": "315-422-7066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PODIATRY SERVICES OF CENTRAL NEW YORK, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-09",
        "last_updated": "2016-10-19",
        "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": "NY",
            "license": "N002777-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; 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.