Provider Demographics
NPI:1851566632
Name:R K RETTIG PODIATRY ASSOCIATES
Entity Type:Organization
Organization Name:R K RETTIG PODIATRY ASSOCIATES
Other - Org Name:R K RETTING PODIATRY ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RETTIG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-927-2837
Mailing Address - Street 1:1335 W TABOR RD STE 206
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3040
Mailing Address - Country:US
Mailing Address - Phone:215-927-2837
Mailing Address - Fax:
Practice Address - Street 1:1335 W TABOR RD STE 206
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3040
Practice Address - Country:US
Practice Address - Phone:215-927-2837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002203-L213E00000X
PASC-002203-L332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty