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General NPI Number Information
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NPI Number | 1316120983
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE PODIATRIC CARE CENTER PC
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 02/04/2014
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Provider Practice Location Address
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Address Line | 2429 BROWN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19130-1930
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Country | US
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Telephone | 215-236-4088
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Fax |
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Provider Business Mailing Address
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Address Line | 2429 BROWN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19130-1930
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Country | US
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Telephone | 215-236-4088
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Fax |
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Authorized Official
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Title or Position | PODIATRIST
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Name | MR. KENNETH J DORTONE
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Credential | DPM
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Telephone | 215-236-4088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | SC003609L
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License Number State | PA
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