Provider Demographics
NPI:1265042741
Name:PHILADELPHIA FOOT AND ANKLE LLC
Entity Type:Organization
Organization Name:PHILADELPHIA FOOT AND ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MERMELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-745-6566
Mailing Address - Street 1:1337 COTTMAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-3728
Mailing Address - Country:US
Mailing Address - Phone:215-745-6566
Mailing Address - Fax:215-893-1722
Practice Address - Street 1:1337 COTTMAN AVE STE A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3728
Practice Address - Country:US
Practice Address - Phone:215-745-6566
Practice Address - Fax:215-893-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-09
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty