Provider Demographics
NPI:1972703049
Name:TRUSKIN, SANDRA M (DPM)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:TRUSKIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10990 KNIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-4210
Mailing Address - Country:US
Mailing Address - Phone:215-632-6444
Mailing Address - Fax:215-632-1899
Practice Address - Street 1:10990 KNIGHTS RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-4210
Practice Address - Country:US
Practice Address - Phone:215-632-6444
Practice Address - Fax:215-632-1899
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002344L213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0060358000Other10 DIGIT HMO ID
PA010783Medicare PIN