Provider Demographics
NPI:1265411771
Name:SUTERA & JONES SURGICAL PODIATRY, P.C.
Entity type:Organization
Organization Name:SUTERA & JONES SURGICAL PODIATRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:B
Authorized Official - Last Name:SUTERA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-566-4383
Mailing Address - Street 1:280 N PROVIDENCE RD
Mailing Address - Street 2:UPPER LEVEL
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3527
Mailing Address - Country:US
Mailing Address - Phone:610-566-4383
Mailing Address - Fax:610-566-1856
Practice Address - Street 1:280 N PROVIDENCE RD
Practice Address - Street 2:UPPER LEVEL
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3527
Practice Address - Country:US
Practice Address - Phone:610-566-4383
Practice Address - Fax:610-566-1856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003658L213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU72628Medicare UPIN
PAU41693Medicare UPIN