Provider Demographics
NPI:1952598187
Name:BENNETT L. WOLANSKY, DPM, PA
Entity Type:Organization
Organization Name:BENNETT L. WOLANSKY, DPM, PA
Other - Org Name:UNIVERSITY PODIATRY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENNETT
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOLANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-680-7133
Mailing Address - Street 1:4601 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3817
Mailing Address - Country:US
Mailing Address - Phone:954-680-7133
Mailing Address - Fax:954-680-7135
Practice Address - Street 1:4601 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3817
Practice Address - Country:US
Practice Address - Phone:954-680-7133
Practice Address - Fax:954-680-7135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2066213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU12762Medicare UPIN
FL65128WMedicare PIN
FL24881Medicare PIN