Provider Demographics
NPI:1497931422
Name:DAVID M PIZZANO,DPM LLC
Entity Type:Organization
Organization Name:DAVID M PIZZANO,DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PIZZANO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-429-5776
Mailing Address - Street 1:135 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-5902
Mailing Address - Country:US
Mailing Address - Phone:973-429-5776
Mailing Address - Fax:973-748-0773
Practice Address - Street 1:135 BLOOMFIELD AVE
Practice Address - Street 2:SUITE K
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-5902
Practice Address - Country:US
Practice Address - Phone:973-429-5776
Practice Address - Fax:973-748-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00224900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5484700001Medicare NSC
NJ089032Medicare PIN