Provider Demographics
NPI:1053641431
Name:DR. BRUCE G GREENFIELD DPM PC
Entity Type:Organization
Organization Name:DR. BRUCE G GREENFIELD DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:GREENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:610-449-3344
Mailing Address - Street 1:2800 W TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-5215
Mailing Address - Country:US
Mailing Address - Phone:610-449-3344
Mailing Address - Fax:610-789-6753
Practice Address - Street 1:2800 W TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-5215
Practice Address - Country:US
Practice Address - Phone:610-449-3344
Practice Address - Fax:610-789-6753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC0023171-1213ES0103X
PASCOO2317-1335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008501870001Medicaid
PA058590Medicare PIN
PA0816700001Medicare NSC
PA6362670001Medicare NSC