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General NPI Number Information
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NPI Number | 1669542239
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Entity Type | Organization
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Legal Business Name | GREATER SALEM FAMILY FOOTCARE ASSOCIATES PC
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 198 MAIN ST
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City | SALEM
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State | NH
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Zip | 03079-3113
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Country | US
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Telephone | 603-898-5864
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Fax | 603-898-1207
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Provider Business Mailing Address
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Address Line | 198 MAIN ST GREATER SALEM FAMILY FOOTCARE ASSOCIATES PC
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City | SALEM
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State | NH
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Zip | 03079
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Country | US
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Telephone | 603-898-5864
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Fax | 603-898-1207
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Authorized Official
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Title or Position | OFFICE MGR
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Name | STANLEY A GORGOL
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Credential | DPM
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Telephone | 603-898-5864
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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 |
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License Number State | NH
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