Provider Demographics
NPI:1447277280
Name:NORTHTOWN PODIATRY GROUP PC
Entity type:Organization
Organization Name:NORTHTOWN PODIATRY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KEATING
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:716-838-2983
Mailing Address - Street 1:2121 MAIN ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2693
Mailing Address - Country:US
Mailing Address - Phone:716-838-2983
Mailing Address - Fax:716-838-2942
Practice Address - Street 1:2121 MAIN ST
Practice Address - Street 2:SUITE 214
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2693
Practice Address - Country:US
Practice Address - Phone:716-838-2983
Practice Address - Fax:716-838-2942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1499938OtherGHI
NY01001743Medicaid
NY082315Medicare ID - Type Unspecified
NY01001743Medicaid