Healthcare Provider Details

I. General information

NPI: 1801986146
Provider Name (Legal Business Name): HEALTHDRIVE PODIATRY GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 PENNS TRAIL SUITE 154
NEWTOWN PA
18940-3438
US

IV. Provider business mailing address

100 CROSSING BLVD SUITE 300
FRAMINGHAM MA
01702-5555
US

V. Phone/Fax

Practice location:
  • Phone: 215-675-3005
  • Fax: 888-662-0859
Mailing address:
  • Phone: 617-964-6681
  • Fax: 339-686-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. SHADI ADIB ABBOUD
Title or Position: TREASURER/PRACTICE DIRECTOR
Credential: DPM
Phone: 857-255-0486