Provider Demographics
NPI:1659569887
Name:JAMES J DELORENZO, DPM PLLC
Entity Type:Organization
Organization Name:JAMES J DELORENZO, DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DELORENZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-242-8890
Mailing Address - Street 1:143 HOOKER AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-4936
Mailing Address - Country:US
Mailing Address - Phone:845-897-3338
Mailing Address - Fax:845-897-3335
Practice Address - Street 1:143 HOOKER AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4936
Practice Address - Country:US
Practice Address - Phone:845-897-3338
Practice Address - Fax:845-897-3335
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMES J DELORENZO, DPM PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-12
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005467213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01897896Medicaid
WEU131Medicare PIN
Y25335Medicare UPIN
NY5146400001Medicare NSC