# EASY STRIDE PAIN & INJURY CENTER, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366591596
- **Authorized official:** DR. J GREGORY BANCROFT D.P.M. (PODIATRIST)
- **Authorized official phone:** (215) 222-2225

## Contact information

- **Practice address:** 4014 LANCASTER AVE \# A, PHILADELPHIA, PA 19104-1712
- **Practice address phone:** (215) 222-2225
- **Practice address fax:** (215) 222-3070
- **Mailing address:** 4014 LANCASTER AVE \# A, PHILADELPHIA, PA 19104-1712
- **Mailing address phone:** (215) 222-2225
- **Mailing address fax:** (215) 222-3070

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | SC-001795-L | PA | Yes |

## Other

- **Enumeration date:** 01/09/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0050052704 | AMERICHOICE OF PA INDIVID | PA |
| 05 | — | 0500527 | — | PA |
| 01 | — | 1049959 | KEYSTONE MERCY - EASY STR | PA |
| 01 | — | 1073543559 | NPI INDIVIDUAL | PA |
| 01 | — | 31700 | KEYSTONE MERCY INDIVIDUAL | PA |