JOHN J DISTAZIO DPM NPI 1366414088

NPI Information

NPI: 1366414088
Provider Name: JOHN J DISTAZIO, DPM
Classification: Podiatrist - 213ES0103X
Entity Type: Individual

Specialization: Foot & Ankle Surgery

PECOS Registration: Yes

Address:
495 WATERFRONT DR E
SUITE 230
HOMESTEAD, PA
ZIP 15120
Phone: (412) 461-1108
Get Directions

John J Distazio, DPM is a foot and ankle surgery podiatrist in Homestead, PA. John J Distazio, DPM NPI is 1366414088. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

495 WATERFRONT DR E
SUITE 230
HOMESTEAD, PA
ZIP 15120-140
Phone: (412) 461-1108
Fax: (412) 461-5490

The NPI 1366414088 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 2/6/2006 and was last updated on 4/20/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	213ES0103X	Podiatrist	Foot & Ankle Surgery	SC002842L	PENNSYLVANIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1205011277	OTHER	PENNSYLVANIA	DMERC NPI NUMBER
2	0004134486	OTHER	PENNSYLVANIA	AETNA PIN
3	175132	OTHER	PENNSYLVANIA	HIGHMARK INDIVIDUAL PROV#
4	175132	MEDICARE ID-TYPE UNSPECIFIED	PENNSYLVANIA
5	1316123052	OTHER	PENNSYLVANIA	RR MEDICARE GROUP NPI
6	1009921	OTHER	PENNSYLVANIA	GATEWAY HMO NUMBER
7	1156610001	OTHER	PENNSYLVANIA	DMERC PROV NUMBER
8	T29930	MEDICARE UPIN	PENNSYLVANIA
9	1316123052	OTHER	PENNSYLVANIA	MC GROUP NPI NUMBER
10	0010941370001	MEDICAID	PENNSYLVANIA
11	455619	OTHER	PENNSYLVANIA	HIGHMARK GRP PROV NUMBER
12	175132XXX	OTHER	PENNSYLVANIA	MC GROUP PROV NUMBER
13	1710911912	OTHER	PENNSYLVANIA	HIGHMARK GROUP NPI NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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