Healthcare Provider Details

I. General information

NPI: 1487826905
Provider Name (Legal Business Name): REGIONAL FOOT & ANKLE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MEADE ST STE 201
DUNMORE PA
18512-3197
US

IV. Provider business mailing address

1000 MEADE ST STE 201
DUNMORE PA
18512-3197
US

V. Phone/Fax

Practice location:
  • Phone: 570-963-1974
  • Fax: 570-963-0762
Mailing address:
  • Phone: 570-963-1974
  • Fax: 570-963-0762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ELMO WILLIAM BALDASSARI JR.
Title or Position: OWNER
Credential: DPM
Phone: 570-963-1974