Provider Demographics
NPI:1386702108
Name:GENE PUSATERI DPM INC
Entity type:Organization
Organization Name:GENE PUSATERI DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PUSATERI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-782-6113
Mailing Address - Street 1:80 E MIDLOTHIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44507-2019
Mailing Address - Country:US
Mailing Address - Phone:330-782-6113
Mailing Address - Fax:330-782-9676
Practice Address - Street 1:80 E MIDLOTHIAN BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44507-2019
Practice Address - Country:US
Practice Address - Phone:330-782-6113
Practice Address - Fax:330-782-9676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001684213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0227632Medicaid
OHDG0340Medicare PIN
OH9283941Medicare PIN
OH0227632Medicaid
OH4730650001Medicare NSC