Provider Demographics
NPI:1144284605
Name:FOOT AND ANKLE CENTER, INC
Entity type:Organization
Organization Name: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:S
Authorized Official - Last Name:HETELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-638-3338
Mailing Address - Street 1:2222 BRISTOL PIKE
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5210
Mailing Address - Country:US
Mailing Address - Phone:215-638-3338
Mailing Address - Fax:215-638-3030
Practice Address - Street 1:2222 BRISTOL PIKE
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-5210
Practice Address - Country:US
Practice Address - Phone:215-638-3338
Practice Address - Fax:215-638-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0060599000OtherPERSONAL CHOICE BLUE SHIE
PA0099228OtherHIGHMARK BLUE SHIELD
PA1033324OtherKEYSTONE MERCY
PA0005050870001Medicaid
CF3240OtherPALMETTO GBA
PA0060599000OtherAMERIHEALTH
PA0005050870001Medicaid
PA0772660001Medicare NSC