Provider Demographics
NPI:1790826717
Name:ADVANCED FOOT CARE, P.C.
Entity type:Organization
Organization Name:ADVANCED FOOT CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:GROSS-EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:484-895-3777
Mailing Address - Street 1:940 N NEW ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-2756
Mailing Address - Country:US
Mailing Address - Phone:484-895-3777
Mailing Address - Fax:484-895-3768
Practice Address - Street 1:940 N NEW ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-2756
Practice Address - Country:US
Practice Address - Phone:484-895-3777
Practice Address - Fax:484-895-3768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-11
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASCOO4802L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101907198-0001Medicaid
PA109718Medicare PIN
PA101907198-0001Medicaid