Provider Demographics
NPI:1942406657
Name:JEFFREY WACHTEL, DPM
Entity Type:Organization
Organization Name:JEFFREY WACHTEL, DPM
Other - Org Name:JEFFREY WACHTEL,DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:I
Authorized Official - Last Name:WACHTEL
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:215-368-5355
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:215-368-5355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001361L332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA194135Medicare PIN
PA1029440001Medicare NSC