MEDICARE: PHILADELPHIA FOOT AND ANKLE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213EP1101X	Primary Podiatric Medicine Podiatrist

General Provider Information

NPI Number	:	1265042741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILADELPHIA FOOT AND ANKLE LLC

Provider Business Mailing Address
First Line	:	1337 COTTMAN AVE STE A
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-3728
Country	:	US
Telephone Number	:	215-745-6566
Fax Number	:	215-893-1722

Provider Business Practice Location Address
First Line	:	1337 COTTMAN AVE STE A
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-3728
Country	:	US
Telephone Number	:	215-745-6566
Fax Number	:	215-893-1722

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW MERMELSTEIN
Credential	:
Telephone Number	:	215-745-6566

Provider Enumeration Date	:	08/09/2020
Last Update Date	:	08/10/2022

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