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General NPI Number Information
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NPI Number | 1881404705
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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 | 01/13/2025
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Last Update Date | 01/13/2025
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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 | 19128-1747
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Country | US
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Telephone | 215-593-2878
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Fax |
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Provider Business Mailing Address
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Address Line | 100 FRONT ST STE 970
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-2800
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Country | US
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Telephone |
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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