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General NPI Number Information
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NPI Number | 1164762043
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Entity Type | Organization
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Legal Business Name | ADVANCED FOOT & ANKLE WELLNESS CENTER, PC
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Dates
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Enumeration Date | 02/28/2013
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Last Update Date | 05/18/2015
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Provider Practice Location Address
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Address Line | 860 1ST AVE SUITE 1B
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-4033
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Country | US
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Telephone | 610-822-3900
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Fax | 610-822-3820
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Provider Business Mailing Address
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Address Line | 860 1ST AVE SUITE 1B
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-4033
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Country | US
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Telephone | 610-822-3900
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Fax | 610-822-3820
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MELISSA WAWRZYNEK
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Credential | DPM
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Telephone | 610-822-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | SC006151
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License Number State | PA
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