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General NPI Number Information
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NPI Number | 1780391714
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Entity Type | Organization
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Legal Business Name | GENERALLY PODIATRY LLC
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Dates
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Enumeration Date | 10/31/2022
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 3578 CALUMET ST
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1602
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Country | US
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Telephone | 856-433-4398
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Fax |
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Provider Business Mailing Address
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Address Line | 3578 CALUMET ST
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1602
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Country | US
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Telephone | 856-433-4398
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | ROBERT LEE
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Credential | DPM
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Telephone | 571-332-3049
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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 |
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