Provider Demographics
NPI:1598943458
Name:THEODORE F MERLETTI, DPM, PC
Entity Type:Organization
Organization Name:THEODORE F MERLETTI, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:F
Authorized Official - Last Name:MERLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:716-284-2242
Mailing Address - Street 1:PO BOX 2446
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14302-2446
Mailing Address - Country:US
Mailing Address - Phone:716-284-2242
Mailing Address - Fax:716-205-0012
Practice Address - Street 1:616 PINE AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1754
Practice Address - Country:US
Practice Address - Phone:716-284-2242
Practice Address - Fax:716-205-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-03
Last Update Date:2008-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5577820001Medicare NSC