Healthcare Provider Details

I. General information

NPI: 1093080608
Provider Name (Legal Business Name): PA FOOT AND ANKLE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 E BERTSCH ST
LANSFORD PA
18232-2111
US

IV. Provider business mailing address

175 S 21ST ST 2ND FLOOR
EASTON PA
18042-3835
US

V. Phone/Fax

Practice location:
  • Phone: 570-805-4777
  • Fax: 570-805-4779
Mailing address:
  • Phone: 610-330-9740
  • Fax: 610-330-9742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number StatePA

VIII. Authorized Official

Name: ADAM J. TEICHMAN
Title or Position: OWNER
Credential: DPM
Phone: 610-330-9740