Provider Demographics
NPI:1417938218
Name:DEFRANCO, MARY J (DPM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:DEFRANCO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WILSEY SQ
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3792
Mailing Address - Country:US
Mailing Address - Phone:201-445-5545
Mailing Address - Fax:201-445-8686
Practice Address - Street 1:10 WILSEY SQ
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3792
Practice Address - Country:US
Practice Address - Phone:201-445-5545
Practice Address - Fax:201-445-8686
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01659213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U09568Medicare UPIN