Healthcare Provider Details

I. General information

NPI: 1265042741
Provider Name (Legal Business Name): PHILADELPHIA FOOT AND ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2020
Last Update Date: 08/10/2022
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 COTTMAN AVE STE A
PHILADELPHIA PA
19111-3728
US

IV. Provider business mailing address

1337 COTTMAN AVE STE A
PHILADELPHIA PA
19111-3728
US

V. Phone/Fax

Practice location:
  • Phone: 215-745-6566
  • Fax: 215-893-1722
Mailing address:
  • Phone: 215-745-6566
  • Fax: 215-893-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: ANDREW MERMELSTEIN
Title or Position: OWNER
Credential:
Phone: 215-745-6566