Provider Demographics
NPI:1225234222
Name:BALA PODIATRY ASSOCIATES
Entity Type:Organization
Organization Name:BALA PODIATRY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:B
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-664-0848
Mailing Address - Street 1:327 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2815
Mailing Address - Country:US
Mailing Address - Phone:610-664-0848
Mailing Address - Fax:610-664-7707
Practice Address - Street 1:327 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2815
Practice Address - Country:US
Practice Address - Phone:610-664-0848
Practice Address - Fax:610-664-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001870L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1790806909OtherPHYSICIAN INDIVIDUAL NPI
PA1790806909OtherPHYSICIAN INDIVIDUAL NPI