Organization
BINGHAMTON PODIATRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG WIXSOM D.P.M. (SOLE PROPRIETOR)
(607) 724-1263
Entity
Organization
Contact information
Practice address
38 FRONT ST, # 2B, BINGHAMTON, NY 13905-4712
(607) 724-1263
(607) 724-1263
Mailing address
111 E 14TH ST, ELMIRA HEIGHTS, NY 14903-1303
(607) 734-9539
(607) 734-6293
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00577151
—
NY
Enumeration date
08/11/2006
Last updated
02/17/2011
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