Provider Demographics
NPI:1851411136
Name:PODIATRY ASSOCIATES GROUP LTD
Entity Type:Organization
Organization Name:PODIATRY ASSOCIATES GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESS
Authorized Official - Middle Name:R
Authorized Official - Last Name:DREZNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-678-2776
Mailing Address - Street 1:2603 KEISER BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610
Mailing Address - Country:US
Mailing Address - Phone:610-678-2776
Mailing Address - Fax:610-678-5127
Practice Address - Street 1:2603 KEISER BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610
Practice Address - Country:US
Practice Address - Phone:610-678-2776
Practice Address - Fax:610-678-5127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002144L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T28340Medicare UPIN
003572Medicare ID - Type Unspecified