Charles W Mistretta, DPM, PC

Primary specialty

Foot Surgery PodiatristTaxonomy code 213ES0131X

License

N004011-1 Issued in NY

Legal business name

CHARLES W MISTRETTA, DPM, PC

Practice address

23 Ivy St
Jamestown, NY 14701-8212

Phone

(716) 664-9698

Fax

(716) 661-3851

NPI assigned

Mar 13, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Charles W Mistretta, DPM

Title

President

Phone

(716) 664-9698

Specialties & licenses 1

Addresses

Other identifiers 5

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811020571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 IVY ST",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147018212",
            "telephone_number": "716-664-9698",
            "fax_number": "716-661-3851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 IVY ST",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147018212",
            "telephone_number": "716-664-9698",
            "fax_number": "716-661-3851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES W MISTRETTA, DPM, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MISTRETTA",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "716-664-9698",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": "NY",
            "license": "N004011-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02433021",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF WNY",
            "identifier": "000500968001",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00957731",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA HEALTH CARE",
            "identifier": "00010256401",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENT HEALTH",
            "identifier": "8905546",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Centi-Grice
• Jamie Elizabeth Cercone, RN
• Matthew S Chang, MD
• Megan Chappel, OTR/L
• Charles E Sinatra DDS
• Laurie A Charles, LCSW
• Jeffrey Chase, RN
• Kimbra A Chase, LMSW
• Monir Chaudhry, M.D.
• Chautauqua Adult Day Care Centers, Inc

• Foot Surgery Podiatrist in Jamestown, NY
• Providers in Jamestown, NY by specialty
• Foot Surgery Podiatrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.