Provider Demographics
NPI:1285612762
Name:PODIATRY ASSOCIATES OF JAMESTOWN
Entity type:Organization
Organization Name:PODIATRY ASSOCIATES OF JAMESTOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:T
Authorized Official - Last Name:TUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:716-483-2200
Mailing Address - Street 1:844 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-2520
Mailing Address - Country:US
Mailing Address - Phone:716-483-2200
Mailing Address - Fax:716-487-2885
Practice Address - Street 1:844 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-2520
Practice Address - Country:US
Practice Address - Phone:716-483-2200
Practice Address - Fax:716-487-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01735464Medicaid
PA0065865000OtherBLUE CROSS PERSONAL CHOIC
PA185236OtherBLUE CROSS OF PA
PA0010132000003Medicaid
NY01735464Medicaid
PA0010132000003Medicaid
NY0493780001Medicare NSC
PA=========OtherPRIVATE INSURANCES
NY39614AMedicare PIN
PA185236OtherBLUE CROSS OF PA
PA0010132000003Medicaid
NYCF9990Medicare PIN