Provider Demographics
NPI:1164762043
Name:ADVANCED FOOT & ANKLE WELLNESS CENTER, PC
Entity Type:Organization
Organization Name:ADVANCED FOOT & ANKLE WELLNESS CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAWRZYNEK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-822-3900
Mailing Address - Street 1:860 1ST AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-4033
Mailing Address - Country:US
Mailing Address - Phone:610-822-3900
Mailing Address - Fax:610-822-3820
Practice Address - Street 1:860 1ST AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4033
Practice Address - Country:US
Practice Address - Phone:610-822-3900
Practice Address - Fax:610-822-3820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006151213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6801310001Medicare NSC