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General NPI Number Information
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NPI Number | 1326277492
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Entity Type | Organization
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Legal Business Name | POCONO PODIATRY AND WOUND CARE, LLC.
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Dates
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Enumeration Date | 07/09/2009
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Last Update Date | 08/23/2010
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Provider Practice Location Address
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Address Line | 296 E BROWN ST SUITE B
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-3011
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Country | US
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Telephone | 215-681-8057
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Fax |
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Provider Business Mailing Address
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Address Line | 296 E BROWN ST SUITE B
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-3011
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Country | US
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Telephone | 570-431-0788
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TANJILA MATIN
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Credential | DPM
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Telephone | 570-431-0788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | SC005819
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License Number State | PA
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