Healthcare Provider Details

I. General information

NPI: 1558341958
Provider Name (Legal Business Name): THOMAS PAUL JIUNTA DPM MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 HAYFIELD RD
SHAVERTOWN PA
18708-8025
US

IV. Provider business mailing address

252 HAYFIELD RD
SHAVERTOWN PA
18708-8025
US

V. Phone/Fax

Practice location:
  • Phone: 570-822-6633
  • Fax: 570-675-4910
Mailing address:
  • Phone: 570-822-6633
  • Fax: 570-675-4910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberSC002228L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: