Provider Demographics
NPI:1215602651
Name:NOVA FOOT AND ANKLE
Entity Type:Organization
Organization Name:NOVA FOOT AND ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:267-761-9780
Mailing Address - Street 1:3200 FRANKFORD AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-3217
Mailing Address - Country:US
Mailing Address - Phone:267-761-9780
Mailing Address - Fax:267-761-9781
Practice Address - Street 1:3200 FRANKFORD AVE FL 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-3217
Practice Address - Country:US
Practice Address - Phone:267-761-9780
Practice Address - Fax:267-761-9781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1760688063Medicaid