Provider Demographics
NPI:1669411864
Name:MERLETTI, THEODORE FRANKLIN (DPM)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:FRANKLIN
Last Name:MERLETTI
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 1:616 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1754
Mailing Address - Country:US
Mailing Address - Phone:716-284-2242
Mailing Address - Fax:716-205-0012
Practice Address - Street 1:616 PINE AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1754
Practice Address - Country:US
Practice Address - Phone:716-284-2242
Practice Address - Fax:716-205-0012
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003956-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01220942Medicaid
NYBA0436Medicare PIN
NYT25949Medicare UPIN
NYRA5669Medicare PIN