Provider Demographics
NPI:1417025115
Name:ALLEGANY PODIATRY
Entity Type:Organization
Organization Name:ALLEGANY PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:P
Authorized Official - Last Name:DUBYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:814-726-1411
Mailing Address - Street 1:2 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-4639
Mailing Address - Country:US
Mailing Address - Phone:814-726-1411
Mailing Address - Fax:814-726-1418
Practice Address - Street 1:2 S STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-4639
Practice Address - Country:US
Practice Address - Phone:814-726-1411
Practice Address - Fax:814-726-1418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016609370011Medicaid
PA0016609370011Medicaid
PA0454880002Medicare NSC