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General NPI Number Information
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NPI Number | 1467478891
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Entity Type | Organization
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Legal Business Name | BRIDGEVILLE PODIATRY
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 510 STATION ST
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City | BRIDGEVILLE
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State | PA
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Zip | 15017-2052
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Country | US
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Telephone | 412-221-2241
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Fax | 412-221-2243
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Provider Business Mailing Address
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Address Line | 510 STATION ST
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City | BRIDGEVILLE
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State | PA
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Zip | 15017-2052
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Country | US
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Telephone | 412-221-2241
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Fax | 412-221-2243
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN J ZIMDAHL
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Credential | DPM
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Telephone | 412-221-2241
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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 | SC001780L
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License Number State | PA
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