Provider Demographics
NPI:1003816190
Name:GINSBERG, CARL RICHARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:RICHARD
Last Name:GINSBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 GREENWOOD AVE
Mailing Address - Street 2:SUITE 05A
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2901
Mailing Address - Country:US
Mailing Address - Phone:215-887-3668
Mailing Address - Fax:215-887-5815
Practice Address - Street 1:1250 GREENWOOD AVE
Practice Address - Street 2:SUITE 05A
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2901
Practice Address - Country:US
Practice Address - Phone:215-887-3668
Practice Address - Fax:215-887-5815
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP0001587213E00000X
PASC002590L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00922956/0003Medicaid
PA0048290000OtherKEYSTONE
PA00922956/0003Medicaid
PA0048290000OtherKEYSTONE