Provider Demographics
NPI:1902352875
Name:HARRISBURG FOOT AND ANKLE CENTER ,INC
Entity Type:Organization
Organization Name:HARRISBURG FOOT AND ANKLE CENTER ,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-651-0000
Mailing Address - Street 1:4033 LINGLESTOWN RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-1153
Mailing Address - Country:US
Mailing Address - Phone:717-651-0000
Mailing Address - Fax:717-651-0001
Practice Address - Street 1:300 BRETZ COURT
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWPORT
Practice Address - State:PA
Practice Address - Zip Code:17074-7250
Practice Address - Country:US
Practice Address - Phone:717-651-0000
Practice Address - Fax:717-651-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003731L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA031437Medicare PIN
PA3895930001Medicare NSC