Provider Demographics
NPI:1235192519
Name:ALBERTELLI, TONY J (DPM)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:J
Last Name:ALBERTELLI
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 1:317 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:TARENTUM
Mailing Address - State:PA
Mailing Address - Zip Code:15084-1816
Mailing Address - Country:US
Mailing Address - Phone:724-224-2200
Mailing Address - Fax:724-224-4588
Practice Address - Street 1:317 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15084
Practice Address - Country:US
Practice Address - Phone:724-224-2200
Practice Address - Fax:724-224-4588
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005506213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAV00392Medicare UPIN
PA5382260001Medicare NSC