1780810010 NPI number — JEFFREY NIGRO

Table of content: (NPI 1780810010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780810010 NPI number — JEFFREY NIGRO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY NIGRO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NIGRO ANKLE AND FOOT CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780810010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
127 COLUMBIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANDERGRIFT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15690-1101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-567-7520
Provider Business Mailing Address Fax Number:
724-568-2169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 UNION AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NATRONA HEIGHTS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15065-2133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-226-0544
Provider Business Practice Location Address Fax Number:
724-226-2172
Provider Enumeration Date:
06/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
NIGRO
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
724-226-0544

Provider Taxonomy Codes

  • Taxonomy code: 261QP1100X , with the licence number:  SC003276L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1208087 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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