Healthcare Provider Details

I. General information

NPI: 1699495259
Provider Name (Legal Business Name): EINSTEIN PODIATRY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 W TABOR RD STE 206
PHILADELPHIA PA
19141-3040
US

IV. Provider business mailing address

1335 W TABOR RD STE 206
PHILADELPHIA PA
19141-3040
US

V. Phone/Fax

Practice location:
  • Phone: 215-927-2837
  • Fax: 215-927-2008
Mailing address:
  • Phone: 215-927-2837
  • Fax: 215-927-2008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMAD MALIK
Title or Position: PARTNER
Credential: DPM
Phone: 215-927-2837