1962456483 NPI number — MOUNT JOY FOOT & ANKLE ASSOCIATES, PC

Table of content: (NPI 1962456483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962456483 NPI number — MOUNT JOY FOOT & ANKLE ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNT JOY FOOT & ANKLE ASSOCIATES, PC
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:
SHARON L. GRISSINGER, DPM
Provider Other Organization Name Type Code:
4
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:
1962456483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 FRANK STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT JOY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17552-1422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-653-6350
Provider Business Mailing Address Fax Number:
717-653-8044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 FRANK STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT JOY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17552-1422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-653-6350
Provider Business Practice Location Address Fax Number:
717-653-8044
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRISSINGER
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
717-653-6350

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  SC003235L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: SC003235L . This is a "STATE LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012543390006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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