Provider Demographics
NPI:1316903776
Name:SILVESTRI, MARIO G (DPM)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:G
Last Name:SILVESTRI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5221
Mailing Address - Country:US
Mailing Address - Phone:607-484-3668
Mailing Address - Fax:607-757-9375
Practice Address - Street 1:1003 MONROE ST
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5221
Practice Address - Country:US
Practice Address - Phone:607-484-3668
Practice Address - Fax:607-757-9375
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0043191213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01045629Medicaid
NYU02493Medicare UPIN
NY01045629Medicaid
0862910001Medicare NSC