Provider Demographics
NPI:1215981865
Name:GLENN B. TRUSKIN,DPM
Entity type:Organization
Organization Name:GLENN B. TRUSKIN,DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:TRUSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-742-6767
Mailing Address - Street 1:8019 CASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2733
Mailing Address - Country:US
Mailing Address - Phone:215-742-6767
Mailing Address - Fax:215-742-6519
Practice Address - Street 1:8019 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2733
Practice Address - Country:US
Practice Address - Phone:215-742-6767
Practice Address - Fax:215-742-6519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0318070001Medicare NSC
846623Medicare PIN