Healthcare Provider Details

I. General information

NPI: 1053641431
Provider Name (Legal Business Name): DR. BRUCE G GREENFIELD DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 W TOWNSHIP LINE RD
HAVERTOWN PA
19083-5215
US

IV. Provider business mailing address

2800 W TOWNSHIP LINE RD
HAVERTOWN PA
19083-5215
US

V. Phone/Fax

Practice location:
  • Phone: 610-449-3344
  • Fax: 610-789-6753
Mailing address:
  • Phone: 610-449-3344
  • Fax: 610-789-6753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC0023171-1
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberSCOO2317-1
License Number StatePA

VIII. Authorized Official

Name: DR. BRUCE G GREENFIELD
Title or Position: OWNER
Credential: DOM
Phone: 610-449-3344