Provider Demographics
NPI:1780675504
Name:PHILIP S. PINSKER DPM PC
Entity Type:Organization
Organization Name:PHILIP S. PINSKER DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PINSKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-225-7410
Mailing Address - Street 1:853 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3870
Mailing Address - Country:US
Mailing Address - Phone:724-225-7410
Mailing Address - Fax:724-225-9469
Practice Address - Street 1:853 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3870
Practice Address - Country:US
Practice Address - Phone:724-225-7410
Practice Address - Fax:724-225-9469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002080L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012042660001Medicaid
PA441480931OtherMEDICARE RAILROAD
PAT28480Medicare UPIN
PA0564470002Medicare NSC
PA122387Medicare PIN