Provider Demographics
NPI:1497719694
Name:MARZANO, JOHN C (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:MARZANO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:C
Other - Last Name:MARZANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:984 N BROADWAY
Mailing Address - Street 2:SUITE LL03
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1318
Mailing Address - Country:US
Mailing Address - Phone:914-423-0600
Mailing Address - Fax:866-549-2795
Practice Address - Street 1:984 N BROADWAY
Practice Address - Street 2:SUITE 302
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1318
Practice Address - Country:US
Practice Address - Phone:914-423-0600
Practice Address - Fax:866-549-2795
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003773213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00851987Medicaid
NY480018657OtherINDIVIDUAL RR PROVIDER #
NY4541240001Medicare NSC
NY4541240002Medicare NSC
NYP3944100Medicare ID - Type Unspecified
NY480018657OtherINDIVIDUAL RR PROVIDER #