# PODIATRY AFFILIATE OF ROCHESTER PLLC

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

## Provider details

- **NPI number:** 1710490263
- **Authorized official:** DR. JOHN ELLIE JR. DPM (CEO/PRESIDENT)
- **Authorized official phone:** (585) 642-6100

## Contact information

- **Practice address:** 1500 PORTLAND AVENUE, PODIATRY/MEDICAL SUITE, ROCHESTER, NY 14621-3065
- **Practice address phone:** (585) 642-6100
- **Practice address fax:** (585) 642-6111
- **Mailing address:** 1500 PORTLAND AVENUE, PODIATRY SUITE, ROCHESTER, NY 14621-3065
- **Mailing address phone:** (585) 642-6100
- **Mailing address fax:** (585) 642-6111

## Taxonomy

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

## Other

- **Enumeration date:** 11/07/2017
- **Last updated:** 03/14/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 05448155 | — | NY |