1740243922 NPI number — A FOOT ABOVE PODIATRY, INC.

Table of content: (NPI 1740243922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740243922 NPI number — A FOOT ABOVE PODIATRY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A FOOT ABOVE PODIATRY, INC.
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:
1740243922
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 TOWNSHIP LINE RD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
HAVERTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19083-3431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-446-1392
Provider Business Mailing Address Fax Number:
610-449-2933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 TOWNSHIP LINE RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
HAVERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19083-3431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-446-1392
Provider Business Practice Location Address Fax Number:
610-449-2933
Provider Enumeration Date:
04/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MONACO
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-446-1392

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: 2126580000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30003681 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3059832 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1441884 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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