Individual
MARILYN S BOYUKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
4104 OLD VESTAL RD, SUITE 104, VESTAL, NY 13850-3500
(607) 217-5289
(607) 821-0255
Mailing address
4104 OLD VESTAL RD, SUITE 104, VESTAL, NY 13850-3500
(607) 217-5289
(607) 821-0255
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
N006043
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02594714
—
NY
01
—
1447286638
GROUP MEMBER NPI
—
01
—
1831439660
SOUTHERN TIER PODIATRY, GROUP NPI
—
01
—
67743610001
MEDICARE, DME PTAN
—
01
—
DU7701
RR MEDICARE GROUP PTAN
—
01
—
J100088341
SOUTHERN TIER PODIATRY, GROUP PTAN
—
01
—
J400088344
MEDICARE GROUP MEMBER PTAN
—
01
—
P01326012
RR MEDICARE GROUP MEMBER PTAN
—
Enumeration date
06/23/2006
Last updated
06/19/2015
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