1609045079 NPI number — RAPHA FOOT AND ANKLE CENTER

Table of content: (NPI 1609045079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609045079 NPI number — RAPHA FOOT AND ANKLE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAPHA FOOT AND ANKLE CENTER
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:
1609045079
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 LIBERTE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTERBROOK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19087-5721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-584-4143
Provider Business Mailing Address Fax Number:
610-584-4143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4605 FRANKFORD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19124-5803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-289-7007
Provider Business Practice Location Address Fax Number:
215-289-3400
Provider Enumeration Date:
02/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
JONG
Authorized Official Middle Name:
MIN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
215-289-7007

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1009302350001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5288640001 . This is a "MEDICARE NAC (DME)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com