Provider Demographics
NPI:1619035557
Name:THE FOOT AND ANKLE GROUP PC
Entity Type:Organization
Organization Name:THE FOOT AND ANKLE GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BALSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-332-5300
Mailing Address - Street 1:6921 FRANKFORD AVENUE
Mailing Address - Street 2:SUITE D
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135
Mailing Address - Country:US
Mailing Address - Phone:215-332-5300
Mailing Address - Fax:215-332-5228
Practice Address - Street 1:210 ARK RD
Practice Address - Street 2:SUITE 214
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3188
Practice Address - Country:US
Practice Address - Phone:856-234-0195
Practice Address - Fax:856-234-8591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA020266Medicare PIN
NJ020433Medicare PIN
NJ1251900003Medicare NSC
NJ020270Medicare PIN