Provider Demographics
NPI:1609846534
Name:O'HANLON, JOHN MORE (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MORE
Last Name:O'HANLON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:268 ROUTE 202
Mailing Address - Street 2:PO BOX 532
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589-3205
Mailing Address - Country:US
Mailing Address - Phone:914-276-3718
Mailing Address - Fax:914-276-3807
Practice Address - Street 1:268 ROUTE 202
Practice Address - Street 2:SUITE 2
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589-3205
Practice Address - Country:US
Practice Address - Phone:914-276-3718
Practice Address - Fax:914-276-3807
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004581-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T98213Medicare UPIN
P52211Medicare ID - Type Unspecified
P52212Medicare ID - Type Unspecified