Provider Demographics
NPI:1235164815
Name:NIGRO PODIATRY
Entity Type:Organization
Organization Name:NIGRO PODIATRY
Other - Org Name:NIGRO ANKLE AND FOOT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:NIGRO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:724-567-7520
Mailing Address - Street 1:127 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:VANDERGRIFT
Mailing Address - State:PA
Mailing Address - Zip Code:15690-1101
Mailing Address - Country:US
Mailing Address - Phone:724-567-7520
Mailing Address - Fax:724-568-2169
Practice Address - Street 1:127 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:VANDERGRIFT
Practice Address - State:PA
Practice Address - Zip Code:15690-1101
Practice Address - Country:US
Practice Address - Phone:724-567-7520
Practice Address - Fax:724-568-2169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003276L213ES0103X
PASC003358L213ES0103X
PASC005745213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA15637190002Medicaid
PA12080870003Medicaid
PA1013170390001Medicaid
PAU24482Medicare UPIN
PAV04964Medicare UPIN
PA613236Medicare PIN
PA548162Medicare PIN
PA15637190002Medicaid
PA12080870003Medicaid