MEDICARE: JOHN A DEBELLO DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	N004819 1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568402576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN A DEBELLO DPM

Provider Business Mailing Address
First Line	:	37-41 91ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	13372
Country	:	US
Telephone Number	:	718-365-6363
Fax Number	:	718-365-2903

Provider Business Practice Location Address
First Line	:	3201 GRAND CONCOURSE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-1247
Country	:	US
Telephone Number	:	718-365-6363
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	12/06/2011

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