Provider Demographics
NPI:1184629396
Name:TRUSKIN, GLENN BARRY (DPM)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:BARRY
Last Name:TRUSKIN
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 1:8019 CASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2733
Mailing Address - Country:US
Mailing Address - Phone:215-742-6767
Mailing Address - Fax:215-742-6519
Practice Address - Street 1:8019 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2733
Practice Address - Country:US
Practice Address - Phone:215-742-6767
Practice Address - Fax:215-742-6519
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002381-L213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008415800001Medicaid
846627Medicare PIN
PA0008415800001Medicaid
PA0318070001Medicare NSC