# GREEN MOUNTAIN FAMILY PODIATRY PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407909039
- **Authorized official:** DR. JOSE GUILLERMO IRIZARRY D.P.M. (OWNER-PRESIDENT)
- **Authorized official phone:** (518) 499-9264

## Contact information

- **Practice address:** 212 BROADWAY, WHITEHALL, NY 12887-1639
- **Practice address phone:** (518) 499-9264
- **Practice address fax:** (518) 499-9247
- **Mailing address:** 212 BROADWAY, WHITEHALL, NY 12887-1639
- **Mailing address phone:** (518) 499-9264
- **Mailing address fax:** (518) 499-9247

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 003568 | NY | Yes |

## Other

- **Enumeration date:** 01/18/2007
- **Last updated:** 06/21/2018

## 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 |