Provider Demographics
NPI:1437337664
Name:ADVANCED CENTER FOR PODIATRY & WOUND CONTROL
Entity Type:Organization
Organization Name:ADVANCED CENTER FOR PODIATRY & WOUND CONTROL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:STEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-283-1150
Mailing Address - Street 1:265 PINE COVE CT
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-9256
Mailing Address - Country:US
Mailing Address - Phone:570-283-1150
Mailing Address - Fax:570-331-3584
Practice Address - Street 1:265 PINE COVE CT
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-9256
Practice Address - Country:US
Practice Address - Phone:570-283-1150
Practice Address - Fax:570-331-3584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA028137Medicare PIN