Healthcare Provider Details

I. General information

NPI: 1124010152
Provider Name (Legal Business Name): ANKLE AND FOOT MEDICAL CENTERS OF THE DELAWARE VALLEY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MARKET ST MAB #111
PHILADELPHIA PA
19104-3153
US

IV. Provider business mailing address

3801 MARKET ST MAB #111
PHILADELPHIA PA
19104-3153
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-9563
  • Fax: 215-243-8818
Mailing address:
  • Phone: 215-662-9563
  • Fax: 215-243-8818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALAN J MLODZIENSKI
Title or Position: PRESIDENT
Credential: DPM
Phone: 215-662-9563