Provider Demographics
NPI:1891770483
Name:ALLENTOWN FAMILY FOOT CARE PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ALLENTOWN FAMILY FOOT CARE PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-434-7000
Mailing Address - Street 1:2414 WALBERT AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-1326
Mailing Address - Country:US
Mailing Address - Phone:610-434-7000
Mailing Address - Fax:610-434-7029
Practice Address - Street 1:2414 WALBERT AVE
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-1326
Practice Address - Country:US
Practice Address - Phone:610-434-7000
Practice Address - Fax:610-434-7029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015710130006Medicaid
PA0015710130006Medicaid