Basic Information
Provider Information | |||||||||
NPI: | 1760479547 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LENFESTEY | ||||||||
FirstName: | ROBERT | ||||||||
MiddleName: | J | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DPM | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 103 PARKWAY OFFICE COURT | ||||||||
Address2: | SUITE 100 | ||||||||
City: | CARY | ||||||||
State: | NC | ||||||||
PostalCode: | 275187429 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9194813338 | ||||||||
FaxNumber: | 9194672436 | ||||||||
Practice Location | |||||||||
Address1: | 103 PARKWAY OFFICE COURT | ||||||||
Address2: | SUITE 100 | ||||||||
City: | CARY | ||||||||
State: | NC | ||||||||
PostalCode: | 275187429 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9194813338 | ||||||||
FaxNumber: | 9194672436 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/05/2005 | ||||||||
LastUpdateDate: | 10/30/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213EP1101X | 209 | NC | Y |   | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine | 213ES0103X | 209 | NC | N |   | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
ID | Type | State | Issuer | Description | 08127 | 01 | NC | BCBS | OTHER | 8908127 | 05 | NC |   | MEDICAID | 77673 | 01 | NC | MEDCOST | OTHER | 4551564 | 01 | NC | AETNA | OTHER | 480016437 | 01 | NC | RAILROAD MEDICARE | OTHER | 2404087 | 01 | NC | CIGNA | OTHER | 2750108 | 01 | NC | UNITED HEALTHCARE | OTHER |