Provider Demographics
NPI:1801962972
Name:LEDINO, JOHN (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LEDINO
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 1:2401 GRANT BLVD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208-2213
Mailing Address - Country:US
Mailing Address - Phone:315-472-5242
Mailing Address - Fax:
Practice Address - Street 1:2401 GRANT BLVD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-2213
Practice Address - Country:US
Practice Address - Phone:315-472-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0037581213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T26622Medicare UPIN
NY480004159Medicare PIN
NY51625BMedicare PIN