Healthcare Provider Details

I. General information

NPI: 1346403003
Provider Name (Legal Business Name): NYEOTI NYEPAN PUNNI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 12/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 WELSH RD
PHILADELPHIA PA
19115-4659
US

IV. Provider business mailing address

1923 WELSH RD
PHILADELPHIA PA
19115-4659
US

V. Phone/Fax

Practice location:
  • Phone: 215-677-3222
  • Fax: 215-677-3241
Mailing address:
  • Phone: 215-677-3222
  • Fax: 215-677-3241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006182
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: