1013097484 NPI number — DELAWARE COUNTY FOOT AND ANKLE CENTER, P.C.

Table of content: (NPI 1013097484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013097484 NPI number — DELAWARE COUNTY FOOT AND ANKLE CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELAWARE COUNTY FOOT AND ANKLE CENTER, P.C.
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:
1013097484
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
153 HENDERSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GULPH MILLS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19428-2521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-940-6976
Provider Business Mailing Address Fax Number:
610-583-3187

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 MACDADE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOLSOM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19033-2318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-534-7990
Provider Business Practice Location Address Fax Number:
610-583-3187
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMO
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-534-7990

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  SC04816L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: DF1955 . This is a "PA RAILROAD MCR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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