MEDICARE: THOMAS M. DELAURO, DPM, PC

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	213ES0103X	Foot & Ankle Surgery Podiatrist	N2657	NY

General Provider Information

NPI Number	:	1790011179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS M. DELAURO, DPM, PC

Provider Business Mailing Address
First Line	:	438 ARDEN AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-2323
Country	:	US
Telephone Number	:	718-984-5900
Fax Number	:	718-227-0990

Provider Business Practice Location Address
First Line	:	438 ARDEN AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-2323
Country	:	US
Telephone Number	:	718-984-5900
Fax Number	:	718-227-0990

Authorized Official
Title or Position	:	PODIATRIST
Name	:	DR. THOMAS M DELAURO
Credential	:	DPM
Telephone Number	:	718-984-5900

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	10/20/2009

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