Provider Demographics
NPI:1669701413
Name:ADVANCED FOOT & ANKLE ASSOCIATES
Entity type:Organization
Organization Name:ADVANCED FOOT & ANKLE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:LIWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:724-654-5433
Mailing Address - Street 1:1000 S. MERCER ST.
Mailing Address - Street 2:4TH FLOOR JAMESON SOUTH
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-4672
Mailing Address - Country:US
Mailing Address - Phone:724-654-5433
Mailing Address - Fax:724-654-3278
Practice Address - Street 1:1000 S. MERCER ST.
Practice Address - Street 2:4TH FLOOR JAMESON SOUTH
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-4672
Practice Address - Country:US
Practice Address - Phone:724-654-5433
Practice Address - Fax:724-654-3278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005768213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024235280001Medicaid
PADQ0498OtherMEDICARE TRAVELERS
PA2141024OtherHIGHMARK BLUE SHIELD
PADQ0498OtherMEDICARE TRAVELERS
PA6350970001Medicare NSC