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General NPI Number Information
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NPI Number | 1992257711
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Entity Type | Organization
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Legal Business Name | TRI-STATE FOOT AND ANKLE CENTER
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 722 YORKLYN RD SUITE 350
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City | HOCKESSIN
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State | DE
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Zip | 19707
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Country | US
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Telephone | 302-239-1625
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Fax | 302-239-1626
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Provider Business Mailing Address
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Address Line | 722 YORKLYN RD SUITE 350
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City | HOCKESSIN
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State | DE
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Zip | 19707
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Country | US
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Telephone | 302-239-1625
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Fax | 302-239-1626
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Authorized Official
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Title or Position | PODIATRIST
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Name | SANDRA HUDAK
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Credential | DPM
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Telephone | 302-239-1625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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