Healthcare Provider Details

I. General information

NPI: 1902352875
Provider Name (Legal Business Name): HARRISBURG FOOT AND ANKLE CENTER ,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BRETZ COURT SUITE 100
NEWPORT PA
17074-7250
US

IV. Provider business mailing address

4033 LINGLESTOWN RD SUITE 1
HARRISBURG PA
17112-1153
US

V. Phone/Fax

Practice location:
  • Phone: 717-651-0000
  • Fax: 717-651-0001
Mailing address:
  • Phone: 717-651-0000
  • Fax: 717-651-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC003731L
License Number StatePA

VIII. Authorized Official

Name: DR. ALLAN BRIAN GROSSMAN
Title or Position: PRESIDENT
Credential: DPM
Phone: 717-651-0000