MEDICARE: WEST LAWN PODIATRY ASSOC., PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	5343070001	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5343070001	OTHER	PA	DME SUPPLIER NUMBER

General Provider Information

NPI Number	:	1841394384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST LAWN PODIATRY ASSOC., PC

Provider Business Mailing Address
First Line	:	25 STEVENS AVE
Second Line	:
City	:	WEST LAWN
State	:	PA
Zip	:	19609-1425
Country	:	US
Telephone Number	:	610-678-4581
Fax Number	:	610-678-8677

Provider Business Practice Location Address
First Line	:	25 STEVENS AVE
Second Line	:
City	:	WEST LAWN
State	:	PA
Zip	:	19609-1425
Country	:	US
Telephone Number	:	610-678-4581
Fax Number	:	610-678-8677

Authorized Official
Title or Position	:	SECRETARY
Name	:	PAUL C. LAFATA
Credential	:	D.P.M.
Telephone Number	:	610-678-4581

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	08/22/2020

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