Provider Demographics
NPI:1558341958
Name:JIUNTA, THOMAS PAUL (DPM MA)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PAUL
Last Name:JIUNTA
Suffix:
Gender:M
Credentials:DPM MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 HAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SHAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18708-8025
Mailing Address - Country:US
Mailing Address - Phone:570-822-6633
Mailing Address - Fax:570-675-4910
Practice Address - Street 1:252 HAYFIELD RD
Practice Address - Street 2:
Practice Address - City:SHAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18708-8025
Practice Address - Country:US
Practice Address - Phone:570-822-6633
Practice Address - Fax:570-675-4910
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002228L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA355237500OtherSUPPLIER WORKMANS COMP
PA0007980500001Medicaid
PA0652100001OtherDME
PA000145782Medicare ID - Type Unspecified
PA0007980500001Medicaid