Provider Demographics
NPI:1235369059
Name:LABORATORY OF PODIATRIC PATHOLOGY, P.C.
Entity Type:Organization
Organization Name:LABORATORY OF PODIATRIC PATHOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMONT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-238-9831
Mailing Address - Street 1:801 ARCH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-2413
Mailing Address - Country:US
Mailing Address - Phone:215-238-9831
Mailing Address - Fax:215-238-1873
Practice Address - Street 1:801 ARCH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-2413
Practice Address - Country:US
Practice Address - Phone:215-238-9831
Practice Address - Fax:215-238-1873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA021451291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA021451OtherSTATE PERMIT
PALA300113OtherMEDICARE
PA1192666101Medicaid
PA39D0657757OtherCLIA
PALE137290OtherPODIATRY LICENSE
PA291U00000XOtherPROVIDER TAXONOMIES