Provider Demographics
NPI:1154382968
Name:MAIOCCO, JOHN LEONARD (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:LEONARD
Last Name:MAIOCCO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 QUARRY RD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4848
Mailing Address - Country:US
Mailing Address - Phone:203-374-3464
Mailing Address - Fax:203-372-1975
Practice Address - Street 1:112 QUARRY RD
Practice Address - Street 2:SUITE 420
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4848
Practice Address - Country:US
Practice Address - Phone:203-374-3464
Practice Address - Fax:203-372-1975
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000462213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT40774621Medicaid
CT40774621Medicaid
CT0933510001Medicare NSC
CTT22963Medicare UPIN