Healthcare Provider Details

I. General information

NPI: 1922317692
Provider Name (Legal Business Name): WACHTEL PODIATRY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 BETHLEHEM PIKE STE 800-900
MONTGOMERYVILLE PA
18936-9741
US

IV. Provider business mailing address

587 BETHLEHEM PIKE STE 800-900
MONTGOMERYVILLE PA
18936-9741
US

V. Phone/Fax

Practice location:
  • Phone: 215-368-5319
  • Fax: 215-368-0672
Mailing address:
  • Phone: 215-368-5319
  • Fax: 215-368-0672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StatePA
# 8
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StatePA
# 9
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StatePA

VIII. Authorized Official

Name: MRS. JENNIFER BOROWIEC
Title or Position: OFFICE MANAGER
Credential:
Phone: 215-368-5319