Provider Demographics
NPI:1518069749
Name:DEFEO AND LILLY, PC
Entity Type:Organization
Organization Name:DEFEO AND LILLY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:DEFEO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-821-0444
Mailing Address - Street 1:3131 COLLEGE HEIGHTS BLVD
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4877
Mailing Address - Country:US
Mailing Address - Phone:610-821-0444
Mailing Address - Fax:610-820-7006
Practice Address - Street 1:3131 COLLEGE HEIGHTS BLVD
Practice Address - Street 2:SUITE 1500
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4877
Practice Address - Country:US
Practice Address - Phone:610-821-0444
Practice Address - Fax:610-820-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001701L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA013746OtherHIGHMARK BLUE SHIELD
0041080000OtherINDEPENDENCE BLUE CROSS
01188301OtherCAPITAL BLUE CROSS
PA013746Medicare PIN
T27061Medicare UPIN
01188301OtherCAPITAL BLUE CROSS