Provider Demographics
NPI:1598755233
Name:HETELSON, ALLAN S (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:S
Last Name:HETELSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 BRISTOL PIKE
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5210
Mailing Address - Country:US
Mailing Address - Phone:215-638-3338
Mailing Address - Fax:215-638-3030
Practice Address - Street 1:2222 BRISTOL PIKE
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-5210
Practice Address - Country:US
Practice Address - Phone:215-638-3338
Practice Address - Fax:215-638-3030
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001286L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0060483000OtherPERSONAL CHOICE
PA0005050690001Medicaid
PA1033250OtherKEYSTONE MERCY
PA0005050690001Medicaid
T27541Medicare UPIN