Provider Demographics
NPI:1386621951
Name:BUDENSTEIN, SAMUEL RICHARD (DPM)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:RICHARD
Last Name:BUDENSTEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14560
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-0560
Mailing Address - Country:US
Mailing Address - Phone:215-677-5120
Mailing Address - Fax:
Practice Address - Street 1:1925 WELSH RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4659
Practice Address - Country:US
Practice Address - Phone:215-677-5120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002557L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0910561Medicaid
PA0910561Medicaid
PABU107900Medicare ID - Type Unspecified