Provider Demographics
NPI:1932121811
Name:POCONO PODIATRY ASSOCIATES
Entity Type:Organization
Organization Name:POCONO PODIATRY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:M
Authorized Official - Last Name:LATZANICH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-424-1031
Mailing Address - Street 1:175 E BROWN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3098
Mailing Address - Country:US
Mailing Address - Phone:570-424-1031
Mailing Address - Fax:570-424-5086
Practice Address - Street 1:175 E BROWN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3098
Practice Address - Country:US
Practice Address - Phone:570-424-1031
Practice Address - Fax:570-424-5086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA480022295OtherRAILROAD MEDICARE
PA480022295OtherRAILROAD MEDICARE
4313570001Medicare NSC