Provider Demographics
NPI:1962456483
Name:MOUNT JOY FOOT & ANKLE ASSOCIATES, PC
Entity Type:Organization
Organization Name:MOUNT JOY FOOT & ANKLE ASSOCIATES, PC
Other - Org Name:SHARON L. GRISSINGER, DPM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRISSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-653-6350
Mailing Address - Street 1:112 FRANK STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNT JOY
Mailing Address - State:PA
Mailing Address - Zip Code:17552-1422
Mailing Address - Country:US
Mailing Address - Phone:717-653-6350
Mailing Address - Fax:717-653-8044
Practice Address - Street 1:112 FRANK STREET
Practice Address - Street 2:
Practice Address - City:MOUNT JOY
Practice Address - State:PA
Practice Address - Zip Code:17552-1422
Practice Address - Country:US
Practice Address - Phone:717-653-6350
Practice Address - Fax:717-653-8044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003235L213E00000X
213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASC003235LOtherSTATE LICENSE
PA0012543390006Medicaid
PA1265950001Medicare NSC
PAU03004Medicare UPIN
PA200747Medicare PIN