Healthcare Provider Details

I. General information

NPI: 1548288749
Provider Name (Legal Business Name): MARTIN J SNYDER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 PITTSTON AVE
SCRANTON PA
18505-4110
US

IV. Provider business mailing address

1003 PITTSTON AVE
SCRANTON PA
18505-4110
US

V. Phone/Fax

Practice location:
  • Phone: 570-343-1842
  • Fax: 570-343-3597
Mailing address:
  • Phone: 570-343-1842
  • Fax: 570-343-3597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC002113L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberSC002113L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: