Provider Demographics
NPI:1073379079
Name:INTEGRATED FOOT AND ANKLE SPECIALISTS OF PA LLC
Entity Type:Organization
Organization Name:INTEGRATED FOOT AND ANKLE SPECIALISTS OF PA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:LEONARDA
Authorized Official - Last Name:CIACCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-993-8666
Mailing Address - Street 1:50 S 16TH ST FL 17
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-3530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 GRANITE RUN DR STE 160
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6819
Practice Address - Country:US
Practice Address - Phone:717-560-4310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATED FOOT AND ANKLE SPECIALISTS OF PA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-27
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies