Provider Demographics
NPI:1780810010
Name:JEFFREY NIGRO
Entity type:Organization
Organization Name:JEFFREY NIGRO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:NIGRO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:724-226-0544
Mailing Address - Street 1:127 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:VANDERGRIFT
Mailing Address - State:PA
Mailing Address - Zip Code:15690-1101
Mailing Address - Country:US
Mailing Address - Phone:724-567-7520
Mailing Address - Fax:724-568-2169
Practice Address - Street 1:1601 UNION AVE
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2133
Practice Address - Country:US
Practice Address - Phone:724-226-0544
Practice Address - Fax:724-226-2172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003276L261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1208087Medicaid
PANI548162Medicare PIN
PAT84870Medicare UPIN
PA1208087Medicaid
0863340003Medicare NSC