Provider Demographics
NPI:1548208218
Name:ANKLE & FOOT SURGICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ANKLE & FOOT SURGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PELLECCHIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-947-9338
Mailing Address - Street 1:1650 HUNTINGDON PIKE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8004
Mailing Address - Country:US
Mailing Address - Phone:215-947-9338
Mailing Address - Fax:215-947-8407
Practice Address - Street 1:1650 HUNTINGDON PIKE
Practice Address - Street 2:SUITE 105
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8004
Practice Address - Country:US
Practice Address - Phone:215-947-9338
Practice Address - Fax:215-947-8407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA043236200OtherINDEPENDENCE BLUE CROSS
PA0004647853OtherAETNA
PA1205530Medicaid
609561Medicare ID - Type Unspecified