Provider Demographics
NPI:1841394384
Name:WEST LAWN PODIATRY ASSOC., PC
Entity Type:Organization
Organization Name:WEST LAWN PODIATRY ASSOC., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAFATA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-678-4581
Mailing Address - Street 1:25 STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-1425
Mailing Address - Country:US
Mailing Address - Phone:610-678-4581
Mailing Address - Fax:610-678-8677
Practice Address - Street 1:25 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-1425
Practice Address - Country:US
Practice Address - Phone:610-678-4581
Practice Address - Fax:610-678-8677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA5343070001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5343070001OtherDME SUPPLIER NUMBER