Provider Demographics
NPI:1700818853
Name:BUSHTA, JOHN FRANCIS (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FRANCIS
Last Name:BUSHTA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-2031
Mailing Address - Country:US
Mailing Address - Phone:570-489-4784
Mailing Address - Fax:570-489-4785
Practice Address - Street 1:1439 MAIN ST
Practice Address - Street 2:
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-2031
Practice Address - Country:US
Practice Address - Phone:570-489-4784
Practice Address - Fax:570-489-4785
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003714L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014503400002Medicaid
PA1023730001Medicare NSC
BU758968Medicare ID - Type Unspecified
U48323Medicare UPIN