Provider Demographics
NPI:1447286638
Name:BOYUKA, MARILYN S (DPM)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:S
Last Name:BOYUKA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 OLD VESTAL RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3500
Mailing Address - Country:US
Mailing Address - Phone:607-217-5289
Mailing Address - Fax:607-821-0255
Practice Address - Street 1:4104 OLD VESTAL RD
Practice Address - Street 2:SUITE 104
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3500
Practice Address - Country:US
Practice Address - Phone:607-217-5289
Practice Address - Fax:607-821-0255
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006043213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1447286638OtherGROUP MEMBER NPI
P01326012OtherRR MEDICARE GROUP MEMBER PTAN
1831439660OtherSOUTHERN TIER PODIATRY, GROUP NPI
DU7701OtherRR MEDICARE GROUP PTAN
67743610001OtherMEDICARE, DME PTAN
J100088341OtherSOUTHERN TIER PODIATRY, GROUP PTAN
NY02594714Medicaid
J400088344OtherMEDICARE GROUP MEMBER PTAN
P01326012OtherRR MEDICARE GROUP MEMBER PTAN