| Organization Name: | MONROE PODIATRY GROUP |
| NPI Number: | 1023189842 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RAYMOND DIVASTO (OWNER) |
| Mailing Address: | 45 North Ave Webster |
| State: | NY US |
| Postal Code: | 145803054 |
| Phone Number: | 5858726520 |
| Fax Number: | 5858726357 |
| NPI Enumeration Date: | 11/13/2006 |
| NPI Last Update Date: | 07/01/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | ========= |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |