Provider Demographics
NPI:1487874947
Name:JOHN ERIC DECATO DPM INC
Entity type:Organization
Organization Name:JOHN ERIC DECATO DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:DECATO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-992-4477
Mailing Address - Street 1:3903 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-5833
Mailing Address - Country:US
Mailing Address - Phone:440-992-4477
Mailing Address - Fax:440-998-5452
Practice Address - Street 1:3903 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-5833
Practice Address - Country:US
Practice Address - Phone:440-992-4477
Practice Address - Fax:440-998-5452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0905015Medicaid
OH0905015Medicaid
OH9283511Medicare PIN
OH0254440001Medicare NSC