Provider Demographics
NPI:1831507284
Name:DR DIRESTA AND ASSOCIATES PLLC
Entity type:Organization
Organization Name:DR DIRESTA AND ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-465-2122
Mailing Address - Street 1:37 1/2 FORRESTER ST
Mailing Address - Street 2:PROFESSIONAL BUILDING
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-1938
Mailing Address - Country:US
Mailing Address - Phone:978-465-2122
Mailing Address - Fax:978-465-0450
Practice Address - Street 1:37 1/2 FORRESTER ST
Practice Address - Street 2:PROFESSIONAL BUILDING
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-1938
Practice Address - Country:US
Practice Address - Phone:978-465-2122
Practice Address - Fax:978-465-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1523213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty