Provider Demographics
NPI:1710335476
Name:FOOT AND ANKLE EXCELLENCE, INC
Entity Type:Organization
Organization Name:FOOT AND ANKLE EXCELLENCE, INC
Other - Org Name:FOOT AND ANKLE EXCELLENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUNI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEKA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-698-6133
Mailing Address - Street 1:1927 GOODNAW ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4720
Mailing Address - Country:US
Mailing Address - Phone:215-698-6133
Mailing Address - Fax:215-698-6144
Practice Address - Street 1:1900 GRANT AVE STE B
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4370
Practice Address - Country:US
Practice Address - Phone:215-698-6133
Practice Address - Fax:215-698-6144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006479213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032590600001Medicaid