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General NPI Number Information
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NPI Number | 1588311625
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Entity Type | Organization
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Legal Business Name | INTEGRATED FOOT AND ANKLE SPECIALISTS OF PA LLC
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Dates
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Enumeration Date | 03/08/2022
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 123 CHESTNUT ST STE 201
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City | PHILADELPHIA
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State | PA
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Zip | 19106-3051
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Country | US
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Telephone | 215-923-2455
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Fax | 484-535-5446
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Provider Business Mailing Address
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Address Line | 123 CHESTNUT ST STE 201
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City | PHILADELPHIA
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State | PA
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Zip | 19106-3051
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Country | US
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Telephone | 856-702-2500
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | TERESA LEONARDA CIACCIO
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Credential |
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Telephone | 516-993-8666
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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 |
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License Number State |
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