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General NPI Number Information
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NPI Number | 1609045079
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Entity Type | Organization
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Legal Business Name | RAPHA FOOT AND ANKLE CENTER
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Dates
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Enumeration Date | 02/29/2008
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 4605 FRANKFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19124-5803
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Country | US
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Telephone | 215-289-7007
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Fax | 215-289-3400
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Provider Business Mailing Address
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Address Line | 10 LIBERTE LN
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City | CHESTERBROOK
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State | PA
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Zip | 19087-5721
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Country | US
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Telephone | 610-584-4143
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Fax | 610-584-4143
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Authorized Official
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Title or Position | OWNER
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Name | DR. JONG MIN LEE
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Credential | DPM
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Telephone | 215-289-7007
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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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