Provider Demographics
NPI:1649403049
Name:ART OF PODIATRY LLC
Entity Type:Organization
Organization Name:ART OF PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANCENITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-880-3427
Mailing Address - Street 1:450 W CAMPING AREA RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315-2122
Mailing Address - Country:US
Mailing Address - Phone:717-880-3427
Mailing Address - Fax:
Practice Address - Street 1:387 7TH ST NW
Practice Address - Street 2:
Practice Address - City:SIOUX CENTER
Practice Address - State:IA
Practice Address - Zip Code:51250-1903
Practice Address - Country:US
Practice Address - Phone:717-880-3427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA167284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital