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General NPI Number Information
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NPI Number | 1366591596
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Entity Type | Organization
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Legal Business Name | EASY STRIDE PAIN & INJURY CENTER, PC
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4014 LANCASTER AVE # A
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City | PHILADELPHIA
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State | PA
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Zip | 19104-1712
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Country | US
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Telephone | 215-222-2225
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Fax | 215-222-3070
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Provider Business Mailing Address
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Address Line | 4014 LANCASTER AVE # A
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City | PHILADELPHIA
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State | PA
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Zip | 19104-1712
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Country | US
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Telephone | 215-222-2225
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Fax | 215-222-3070
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. J GREGORY BANCROFT
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Credential | D.P.M.
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Telephone | 215-222-2225
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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 | SC-001795-L
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License Number State | PA
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