Provider Demographics
NPI:1659557361
Name:ALLEN A DZAMBO JR DPM
Entity Type:Organization
Organization Name:ALLEN A DZAMBO JR DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:DZAMBO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:724-539-3444
Mailing Address - Street 1:1200 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1915
Mailing Address - Country:US
Mailing Address - Phone:724-539-3444
Mailing Address - Fax:
Practice Address - Street 1:1200 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1915
Practice Address - Country:US
Practice Address - Phone:724-539-3444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004642L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA17663730003Medicaid
PA17663730003Medicaid
PA5905140001Medicare NSC