Provider Demographics
NPI:1265630438
Name:DPMNOELPRPA LLC
Entity type:Organization
Organization Name:DPMNOELPRPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:NOEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-447-8313
Mailing Address - Street 1:1923 WELSH RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4659
Mailing Address - Country:US
Mailing Address - Phone:800-645-0721
Mailing Address - Fax:215-677-3241
Practice Address - Street 1:3209 EDGMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-3104
Practice Address - Country:US
Practice Address - Phone:800-645-0721
Practice Address - Fax:610-874-0277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005973213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU91088Medicare UPIN