Provider Demographics
NPI:1447211651
Name:MASTRANGELO, JOHN JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:MASTRANGELO
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 1:214 W BLOOMFIELD ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-4241
Mailing Address - Country:US
Mailing Address - Phone:315-336-1331
Mailing Address - Fax:315-336-1331
Practice Address - Street 1:214 W BLOOMFIELD ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-4241
Practice Address - Country:US
Practice Address - Phone:315-336-1331
Practice Address - Fax:315-336-1331
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002892213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJM33169BMedicare ID - Type Unspecified
NYT56142Medicare UPIN