Provider Demographics
NPI:1821391434
Name:NORTHEAST FOOT AND ANKLE SPECIALISTS, PC
Entity Type:Organization
Organization Name:NORTHEAST FOOT AND ANKLE SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHEYEV
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-464-2000
Mailing Address - Street 1:9922 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1705
Mailing Address - Country:US
Mailing Address - Phone:215-464-2000
Mailing Address - Fax:215-464-6046
Practice Address - Street 1:9922 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-1705
Practice Address - Country:US
Practice Address - Phone:215-464-2000
Practice Address - Fax:215-464-6046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-009751213EP1101X, 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
PA6566290001Medicare NSC
PA112461YDF0Medicare PIN