Provider Demographics
NPI:1487658852
Name:WEST LAWN PODIATRY ASSOCIATES P.C.
Entity Type:Organization
Organization Name:WEST LAWN PODIATRY ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETART
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAFATA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-678-4581
Mailing Address - Street 1:25 STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-1424
Mailing Address - Country:US
Mailing Address - Phone:610-678-4581
Mailing Address - Fax:610-678-4599
Practice Address - Street 1:25 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-1424
Practice Address - Country:US
Practice Address - Phone:610-678-4581
Practice Address - Fax:610-678-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004661L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5343070001Medicare NSC