Individual
CHARLES W MISTRETTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
23 IVY ST, JAMESTOWN, NY 14701-8212
(716) 664-9698
Mailing address
23 IVY ST, JAMESTOWN, NY 14701-8212
(716) 664-9698
(716) 661-3851
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
N4011
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00957731
—
NY
01
—
AA1409
MEDICARE-PTAN
NY
Enumeration date
08/09/2006
Last updated
09/12/2011
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