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General NPI Number Information
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NPI Number | 1487826905
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Entity Type | Organization
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Legal Business Name | REGIONAL FOOT & ANKLE CENTER PC
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 04/10/2019
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Provider Practice Location Address
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Address Line | 1439 MONROE AVE STE 3
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City | DUNMORE
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State | PA
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Zip | 18509-2497
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Country | US
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Telephone | 570-963-1974
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Fax | 570-963-0762
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Provider Business Mailing Address
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Address Line | 1439 MONROE AVE STE 3
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City | DUNMORE
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State | PA
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Zip | 18509-2497
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Country | US
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Telephone | 570-963-1974
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Fax | 570-963-0762
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELMO WILLIAM BALDASSARI JR.
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Credential | DPM
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Telephone | 570-963-1974
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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 | SC003666L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | SC-003666L
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License Number State | PA
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