Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC-002702 L | PA |
Y | 222Z00000X | Podiatrist | SC-002702 L | PA |
NPI | 1053309716 |
---|---|
Provider Name | Dr. Jerome P Casey |
First Address | Archbald, PA 18403-2101 |
Second Address | Archbald, PA 18403-2101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2005 |
Last Update Date | 23/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T30293 | (02) | PA |