Provider Demographics
NPI:1568854412
Name:A1 FOOT AND ANKLE CLINIC
Entity Type:Organization
Organization Name:A1 FOOT AND ANKLE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MED, DPM
Authorized Official - Phone:724-224-2498
Mailing Address - Street 1:2130 FREEPORT RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-1542
Mailing Address - Country:US
Mailing Address - Phone:724-224-2498
Mailing Address - Fax:724-224-1192
Practice Address - Street 1:2130 FREEPORT RD
Practice Address - Street 2:SUITE A
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-1542
Practice Address - Country:US
Practice Address - Phone:724-224-2498
Practice Address - Fax:724-224-1192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005921213EP1101X, 213ER0200X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023993420002Medicaid
PA137985OtherMEDICARE PTAN