Provider Demographics
NPI:1154322030
Name:DELAURO, THOMAS M (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:DELAURO
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 1:438 ARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2323
Mailing Address - Country:US
Mailing Address - Phone:718-984-5900
Mailing Address - Fax:718-227-0990
Practice Address - Street 1:438 ARDEN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-2323
Practice Address - Country:US
Practice Address - Phone:718-984-5900
Practice Address - Fax:718-227-0990
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2010-10-12
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
NYN2657213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP31183Medicare PIN
NYP31181Medicare PIN