Provider Demographics
NPI:1992257711
Name:TRI-STATE FOOT AND ANKLE CENTER
Entity type:Organization
Organization Name:TRI-STATE FOOT AND ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDAK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:302-239-1625
Mailing Address - Street 1:722 YORKLYN RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707
Mailing Address - Country:US
Mailing Address - Phone:302-239-1625
Mailing Address - Fax:302-239-1626
Practice Address - Street 1:722 YORKLYN RD
Practice Address - Street 2:SUITE 350
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707
Practice Address - Country:US
Practice Address - Phone:302-239-1625
Practice Address - Fax:302-239-1626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric