Provider Demographics
NPI:1639274632
Name:ACE PODIATRY PA
Entity Type:Organization
Organization Name:ACE PODIATRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-638-8635
Mailing Address - Street 1:5175 W ATLANTIC AVE STE F
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8101
Mailing Address - Country:US
Mailing Address - Phone:561-638-8635
Mailing Address - Fax:561-638-8635
Practice Address - Street 1:5175 W ATLANTIC AVE STE F
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8101
Practice Address - Country:US
Practice Address - Phone:561-638-8635
Practice Address - Fax:561-638-8635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0002378213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty