Provider Demographics
NPI:1922317692
Name:WACHTEL PODIATRY GROUP, LLC
Entity Type:Organization
Organization Name:WACHTEL PODIATRY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOROWIEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-368-5319
Mailing Address - Street 1:2032 N BROAD ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1051
Mailing Address - Country:US
Mailing Address - Phone:215-368-5319
Mailing Address - Fax:215-368-0672
Practice Address - Street 1:2032 N BROAD ST
Practice Address - Street 2:SUITE 4
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1051
Practice Address - Country:US
Practice Address - Phone:215-368-5319
Practice Address - Fax:215-368-0672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA213E00000X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0103X, 213ES0131X, 332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiologyGroup - Multi-Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6469030001Medicare NSC
PAT27577Medicare UPIN