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General NPI Number Information
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NPI Number | 1194083790
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Entity Type | Organization
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Legal Business Name | JOHN J DEGOVANN DPM PC
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Dates
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Enumeration Date | 05/02/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5735 RIDGE AVE STE 203
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City | PHILADELPHIA
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State | PA
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Zip | 19128-1747
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Country | US
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Telephone | 215-487-0475
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Fax | 215-487-0171
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Provider Business Mailing Address
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Address Line | 5735 RIDGE AVE STE 203
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City | PHILADELPHIA
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State | PA
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Zip | 19128-1747
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Country | US
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Telephone | 215-487-0475
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Fax | 215-487-0171
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES D SANDY
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Credential | DPM
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Telephone | 215-487-0475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number | SC001467L
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License Number State | PA
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