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General NPI Number Information
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NPI Number | 1588980114
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Entity Type | Organization
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Legal Business Name | CENTER FOR FOOT & ANKLE EXCELLENCE
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Dates
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Enumeration Date | 04/07/2010
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Last Update Date | 12/31/2013
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Provider Practice Location Address
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Address Line | 5735 RIDGE AVE STE 208
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City | PHILADELPHIA
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State | PA
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Zip | 19128-1745
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Country | US
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Telephone | 215-483-2006
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Fax | 215-483-2066
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Provider Business Mailing Address
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Address Line | 5735 RIDGE AVE STE 208
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City | PHILADELPHIA
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State | PA
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Zip | 19128-1745
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Country | US
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Telephone | 215-483-2006
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Fax | 215-483-2066
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. LARRY GOSS
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Credential | DPM
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Telephone | 215-483-2006
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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 | SC004111L
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License Number State | PA
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