Provider Demographics
NPI:1285821074
Name:JOHN F BUSHTA DPM PC
Entity Type:Organization
Organization Name:JOHN F BUSHTA DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BUSHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-489-4784
Mailing Address - Street 1:1439 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-2031
Mailing Address - Country:US
Mailing Address - Phone:570-489-4784
Mailing Address - Fax:570-489-4583
Practice Address - Street 1:1439 MAIN ST
Practice Address - Street 2:
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-2031
Practice Address - Country:US
Practice Address - Phone:570-489-4784
Practice Address - Fax:570-489-4583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003714L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U48323Medicare UPIN
PA758968Medicare PIN
PA1023730001Medicare NSC