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General NPI Number Information
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NPI Number | 1366435653
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Entity Type | Organization
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Legal Business Name | NORTH CENTRAL PENN PODIATRY PC
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 11/12/2007
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Provider Practice Location Address
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Address Line | 103 WEST AVE
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City | WELLSBORO
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State | PA
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Zip | 16901-1358
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Country | US
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Telephone | 570-724-5297
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Fax | 570-724-8793
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Provider Business Mailing Address
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Address Line | 103 WEST AVE
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City | WELLSBORO
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State | PA
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Zip | 16901-1358
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Country | US
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Telephone | 570-724-5297
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Fax | 570-724-8793
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Authorized Official
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Title or Position | OWNER
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Name | STEVAN J ANSELMI
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Credential | DPM
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Telephone | 570-724-5297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | SC0018534
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License Number State | PA
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