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Organization
GREEN MOUNTAIN FAMILY PODIATRY PC
Active
Organization
GREEN MOUNTAIN FAMILY PODIATRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSE GUILLERMO IRIZARRY D.P.M. (OWNER-PRESIDENT)
(518) 499-9264
Entity
Organization
Contact information
Practice address
212 BROADWAY, WHITEHALL, NY 12887-1639
(518) 499-9264
(518) 499-9247
Mailing address
212 BROADWAY, WHITEHALL, NY 12887-1639
(518) 499-9264
(518) 499-9247
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
003568
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00028868
BCBS VERMONT
VT
01
—
000470542001
BLUESHIELD HEALTHNOW
NY
05
—
00810586
—
NY
01
—
041210000033
FIDELIS
NY
01
—
1005566
VERMONT MEDICAID
VT
01
—
59591
MVP HEALTH CARE
NY
01
—
9659860-99
GHI
NY
01
—
P3899
EMPIRE BLUE CROSS
NY
01
—
PAW48
EMPIRE BLUE CROSS
NY
Enumeration date
01/18/2007
Last updated
06/21/2018
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