Provider Demographics
NPI:1962145979
Name:ONE FOOT FORWARD PODIATRY PC
Entity type:Organization
Organization Name:ONE FOOT FORWARD PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-635-7092
Mailing Address - Street 1:20980 CIPRES WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-1604
Mailing Address - Country:US
Mailing Address - Phone:267-635-7092
Mailing Address - Fax:315-612-9793
Practice Address - Street 1:9501 STATE RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-3053
Practice Address - Country:US
Practice Address - Phone:646-921-0907
Practice Address - Fax:315-612-9793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-18
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASC007233OtherPENNSYLVANIA