1598070658 NPI number — NORTH PENN PODIATRY LLC

Table of content: (NPI 1598070658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598070658 NPI number — NORTH PENN PODIATRY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH PENN PODIATRY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598070658
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
914 N BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANSDALE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19446-2328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-855-8122
Provider Business Mailing Address Fax Number:
215-855-7908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
914 N BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANSDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19446-2328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-855-8122
Provider Business Practice Location Address Fax Number:
215-855-7908
Provider Enumeration Date:
08/13/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KOKALARI
Authorized Official First Name:
DARIEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-337-3322

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  SC001515L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)