Provider Demographics
NPI:1396857397
Name:PISERCHIA, THOMAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:PISERCHIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1017
Mailing Address - Street 2:22 CANAL STREET
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-0271
Mailing Address - Country:US
Mailing Address - Phone:845-856-6831
Mailing Address - Fax:845-856-3310
Practice Address - Street 1:22 CANAL ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-1638
Practice Address - Country:US
Practice Address - Phone:845-856-6831
Practice Address - Fax:845-856-3310
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY133976207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY200002990OtherMEDICARE RAILROAD
NY200002990OtherMEDICARE RAILROAD
NYA63167Medicare UPIN