Provider Demographics
NPI:1336274992
Name:PINSKER, PHILIP S (DPM)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:S
Last Name:PINSKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3870
Mailing Address - Country:US
Mailing Address - Phone:724-225-7410
Mailing Address - Fax:724-225-9469
Practice Address - Street 1:853 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3870
Practice Address - Country:US
Practice Address - Phone:724-225-7410
Practice Address - Fax:724-225-9469
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002080L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005403530001Medicaid
PA0005403530001Medicaid
PA094615XZ3Medicare PIN
T28480Medicare UPIN