MEDICARE: PETER P SIDORIAK

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1356523286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER P SIDORIAK

Provider Business Mailing Address
First Line	:	1851 W END AVE
Second Line	:
City	:	POTTSVILLE
State	:	PA
Zip	:	17901-2050
Country	:	US
Telephone Number	:	570-622-3668
Fax Number	:	570-622-2920

Provider Business Practice Location Address
First Line	:	1851 W END AVE
Second Line	:
City	:	POTTSVILLE
State	:	PA
Zip	:	17901-2050
Country	:	US
Telephone Number	:	570-622-3668
Fax Number	:	570-622-2920

Authorized Official
Title or Position	:	PODIATRIST
Name	:	DR. PETER P SIDORIAK
Credential	:	DPM
Telephone Number	:	570-622-3668

Provider Enumeration Date	:	12/03/2007
Last Update Date	:	12/03/2007

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Directions to “PETER P SIDORIAK ” Practice Location

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