Provider Demographics
NPI:1235188913
Name:WACHTEL, JEFFREY I (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:I
Last Name:WACHTEL
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 1:148 CANTERBURY LN
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1278
Mailing Address - Country:US
Mailing Address - Phone:610-275-1984
Mailing Address - Fax:610-275-1303
Practice Address - Street 1:2032 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1051
Practice Address - Country:US
Practice Address - Phone:215-368-5319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001361L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA48624GPSMedicare PIN
PAT27577Medicare UPIN