Provider Demographics
NPI:1124010152
Name:ANKLE AND FOOT MEDICAL CENTERS OF THE DELAWARE VALLEY PC
Entity Type:Organization
Organization Name:ANKLE AND FOOT MEDICAL CENTERS OF THE DELAWARE VALLEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MLODZIENSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-662-9563
Mailing Address - Street 1:3801 MARKET ST
Mailing Address - Street 2:MAB #111
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3153
Mailing Address - Country:US
Mailing Address - Phone:215-662-9563
Mailing Address - Fax:215-243-8818
Practice Address - Street 1:3801 MARKET ST
Practice Address - Street 2:MAB #111
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3153
Practice Address - Country:US
Practice Address - Phone:215-662-9563
Practice Address - Fax:215-243-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017329000002Medicaid
024142Medicare PIN
PA4638080001Medicare NSC