Healthcare Provider Details

I. General information

NPI: 1851566632
Provider Name (Legal Business Name): R K RETTIG PODIATRY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 12/30/2013
Certification Date:
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:
Mailing address:
  • Phone: 215-927-2837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberSC-002203-L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC002203-L
License Number StatePA

VIII. Authorized Official

Name: DR. RICHARD RETTIG
Title or Position: PODIATRIST
Credential: DPM
Phone: 215-927-2837