Provider Demographics
NPI:1770531139
Name:TWIN RIVERS PODIATRY P A
Entity type:Organization
Organization Name:TWIN RIVERS PODIATRY P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFELTI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-533-3543
Mailing Address - Street 1:25 SOUTH BROAD ST
Mailing Address - Street 2:STE 103
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-2167
Mailing Address - Country:US
Mailing Address - Phone:610-759-1326
Mailing Address - Fax:610-789-2773
Practice Address - Street 1:25 SOUTH BROAD ST
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-2167
Practice Address - Country:US
Practice Address - Phone:610-759-1326
Practice Address - Fax:610-759-2773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCI7721OtherRAILROAD MEDICARE PART B
PACN5074OtherRAILROAD MEDICARE PART B
NJ901567Medicare PIN
NJCI7721OtherRAILROAD MEDICARE PART B
PA4203200001Medicare NSC