Individual
DIANE H FORTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
2448 ELMWOOD AVE, KENMORE, NY 14217-2244
(716) 875-7878
(716) 875-1240
Mailing address
2448 ELMWOOD AVE, KENMORE, NY 14217-2244
(716) 875-7878
(716) 875-1240
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
NY38591
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010252801
UNIVERA
NY
01
—
000500702001
BCBS
—
05
—
00897347
—
NY
01
—
0094789
GHI
—
01
—
161262434
UNITED
—
01
—
396558
WELLCARE
NY
01
—
8906817
IHA
NY
Enumeration date
03/06/2007
Last updated
12/31/2008
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