# SOUTH CARRIAGE

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

## Provider details

- **NPI number:** 1467962977
- **Authorized official:** JOHN MORIARTY DPM (PHYSICIAN)
- **Authorized official phone:** (585) 331-6752

## Contact information

- **Practice address:** 512 BEACH DR, MEDINA, NY 14103-1004
- **Practice address phone:** (585) 331-6752
- **Practice address fax:** (585) 331-6752
- **Mailing address:** PO BOX 70243, STATEN ISLAND, NY 10307-0243
- **Mailing address phone:** (585) 331-6752

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 006888 | NY | Yes |

## Other

- **Enumeration date:** 10/10/2017
- **Last updated:** 10/10/2017