Provider Demographics
NPI:1639355415
Name:GARY A CORTESE, DPM
Entity Type:Organization
Organization Name:GARY A CORTESE, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-622-2230
Mailing Address - Street 1:48 TUNNEL RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3875
Mailing Address - Country:US
Mailing Address - Phone:570-622-0473
Mailing Address - Fax:570-624-4116
Practice Address - Street 1:1626 MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-1302
Practice Address - Country:US
Practice Address - Phone:570-622-2230
Practice Address - Fax:570-622-5724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002264L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012668300003Medicaid
PA400155OtherHIGHMARK
PAT72806Medicare UPIN
PA0929220001Medicare NSC