Provider Demographics
NPI:1952311656
Name:VISCOVICH, JOHN (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:VISCOVICH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:190 GOLDENS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-2810
Mailing Address - Country:US
Mailing Address - Phone:914-401-8053
Mailing Address - Fax:914-232-3366
Practice Address - Street 1:101 S BEDFORD RD
Practice Address - Street 2:SUITE 213
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3439
Practice Address - Country:US
Practice Address - Phone:914-244-0244
Practice Address - Fax:914-244-0261
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYN005723 1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02264060Medicaid
NY02264060Medicaid
PH0301Medicare ID - Type Unspecified