Provider Demographics
NPI:1336478338
Name:JEROME P. CASEY DPM PC
Entity Type:Organization
Organization Name:JEROME P. CASEY DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:P
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-876-1440
Mailing Address - Street 1:401 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ARCHBALD
Mailing Address - State:PA
Mailing Address - Zip Code:18403-2101
Mailing Address - Country:US
Mailing Address - Phone:570-876-1440
Mailing Address - Fax:570-876-0556
Practice Address - Street 1:401 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ARCHBALD
Practice Address - State:PA
Practice Address - Zip Code:18403-2101
Practice Address - Country:US
Practice Address - Phone:570-876-1440
Practice Address - Fax:570-876-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002702L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA17369OtherGEISINGER
PA817221OtherFIRST PRIORITY HEALTH
PA0009895800001Medicaid
PA3184931OtherAETNA
PA0009895800001Medicaid