Organization
POCONO PODIATRY AND WOUND CARE, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TANJILA MATIN DPM (OWNER)
(570) 431-0788
Entity
Organization
Contact information
Practice address
296 E BROWN ST, SUITE B, EAST STROUDSBURG, PA 18301-3011
(215) 681-8057
Mailing address
296 E BROWN ST, SUITE B, EAST STROUDSBURG, PA 18301-3011
(570) 431-0788
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
SC005819
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101945964
—
PA
Enumeration date
07/09/2009
Last updated
08/23/2010
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