Provider Demographics
NPI:1871777441
Name:MICHAEL FARRELL INC.
Entity type:Organization
Organization Name:MICHAEL FARRELL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:607-563-8167
Mailing Address - Street 1:PO BOX 436
Mailing Address - Street 2:44 PEARL STREET
Mailing Address - City:SIDNEY
Mailing Address - State:NY
Mailing Address - Zip Code:13838-0436
Mailing Address - Country:US
Mailing Address - Phone:607-563-8167
Mailing Address - Fax:
Practice Address - Street 1:44 PEARL ST W
Practice Address - Street 2:44 PEARL STREET
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-1325
Practice Address - Country:US
Practice Address - Phone:607-563-8167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004551213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5664640001OtherDME
NY5664640001OtherDME