Provider Demographics
NPI:1790836047
Name:SENTRA PODIATRY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:SENTRA PODIATRY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-242-8280
Mailing Address - Street 1:7100 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1837
Mailing Address - Country:US
Mailing Address - Phone:215-242-8280
Mailing Address - Fax:215-242-8285
Practice Address - Street 1:7100 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1837
Practice Address - Country:US
Practice Address - Phone:215-242-8280
Practice Address - Fax:215-242-8285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002207-L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007103550005Medicaid
PA0007103550005Medicaid
PA155837Medicare PIN
PA1234170001Medicare NSC