Provider Demographics
NPI:1013961655
Name:FOOT & ANKLE SPECIALTY CENTER, P.C.
Entity Type:Organization
Organization Name:FOOT & ANKLE SPECIALTY CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-659-4400
Mailing Address - Street 1:2400 MARYLAND ROAD
Mailing Address - Street 2:SUITE 30
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1748
Mailing Address - Country:US
Mailing Address - Phone:215-659-4400
Mailing Address - Fax:215-659-5931
Practice Address - Street 1:2400 MARYLAND ROAD
Practice Address - Street 2:SUITE 30
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1748
Practice Address - Country:US
Practice Address - Phone:215-659-4400
Practice Address - Fax:215-659-5931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002408L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012685300004Medicaid
PA0048278000OtherINDEPENDENCE BLUE CROSS
CA4263OtherMEDICARE - PALMETTO GBA
PA199982Medicare PIN
CA4263OtherMEDICARE - PALMETTO GBA