Healthcare Provider Details

I. General information

NPI: 1659339075
Provider Name (Legal Business Name): MICHAEL BENNETT NEWMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 FLORAL VALE BLVD
YARDLEY PA
19067-5528
US

IV. Provider business mailing address

456 E STONEY HILL CT
LANGHORNE PA
19053-1937
US

V. Phone/Fax

Practice location:
  • Phone: 215-968-6700
  • Fax: 215-504-8373
Mailing address:
  • Phone: 215-752-0781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC001564L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0023118000
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerKEYSTONE EAST
# 2
IdentifierSC001564L
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPA. LISCENSE-PODIATRIC
# 3
Identifier1149894
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerKEYSTONE MERCY
# 4
Identifier0016221400005
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: