Healthcare Provider Details

I. General information

NPI: 1245234806
Provider Name (Legal Business Name): JERAULD D FERRITTO JR. D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3774 BROADWAY
GROVE CITY OH
43123-2235
US

IV. Provider business mailing address

3774 BROADWAY
GROVE CITY OH
43123-2235
US

V. Phone/Fax

Practice location:
  • Phone: 614-875-8211
  • Fax: 614-875-0769
Mailing address:
  • Phone: 614-875-8211
  • Fax: 614-875-0769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number36001780
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: