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General NPI Number Information
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NPI Number | 1427154988
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Entity Type | Individual
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Provider Name | MARTIN FRANCIS REALE DPM
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Gender | Male
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 08/18/2009
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Provider Practice Location Address
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Address Line | 1335 W TABOR RD SUITE 302
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City | PHILADELPHIA
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State | PA
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Zip | 19141-3038
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Country | US
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Telephone | 856-697-9090
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Fax |
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Provider Business Mailing Address
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Address Line | 32 DRIFTWOOD COURT
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City | GLASSBORO
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State | NJ
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Zip | 08028-2846
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Country | US
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Telephone | 856-697-9090
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 25MD00134100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | SC002395L
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License Number State | PA
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