Port Washington Podiatry Inc

Primary specialty

PodiatristTaxonomy code 213E00000X

License

798025 Issued in WI

Legal business name

PORT WASHINGTON PODIATRY INC

Practice address

1317 W Grand Avenue
Port Washington Podiatry
Port Washington, WI 53074

Phone

(262) 284-8800

Fax

(262) 284-8861

NPI assigned

Jun 20, 2006

Last updated

Apr 20, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeffrey Joseph Bongiorno, DPMNPI 1770599953

Title

President

Phone

(262) 284-8800

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WI2 enrollments

Enrollment records 2

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeffrey Joseph Bongiorno, DPM

  • Podiatrist
  • Port Washington, WI
  • NPI 1770599953
  Medicare reassignment NPD Authorized official
• Jessica Clayborn, LPC

  • Professional Counselor
  • Port Washington, WI
  • NPI 1740869155
  NPD
• Kari Lynn Di Fonzo, LCSW,

  • Clinical Social Worker
  • Glendale, WI
  • NPI 1508965906
  NPD
• Thomas Karl Galten, LCSW

  • Clinical Social Worker
  • Port Washington, WI
  • NPI 1962525683
  NPD
• Carol L Ramos, LPC

  • Professional Counselor
  • Port Washington, WI
  • NPI 1205030905
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1013953926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2132 WILLOW POND WAY",
            "city": "GRAFTON",
            "state": "WI",
            "postal_code": "530249102",
            "telephone_number": "262-284-8800",
            "fax_number": "262-284-8861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 W GRAND AVENUE",
            "address_2": "PORT WASHINGTON PODIATRY",
            "city": "PORT WASHINGTON",
            "state": "WI",
            "postal_code": "53074",
            "telephone_number": "262-284-8800",
            "fax_number": "262-284-8861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT WASHINGTON PODIATRY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "BONGIORNO",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-284-8800",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "WI",
            "license": "798025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCR",
            "identifier": "DB0746",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43268200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole S Pook, LPN
• Port Chiropractic Inc.
• Port Dental Group SC
• Port Family Pharmacy, Inc.
• Port Family Pharmacy, Inc.
• Port Washington Saukville School District
• Portwashingtonctd1 LLC
• Neal Z. Potash, MS
• Prime Horizon, Inc.
• Nicole Prohuska, APSW

• Podiatrist in Port Washington, WI
• Providers in Port Washington, WI by specialty
• Podiatrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.