Organization
EASY STRIDE PAIN & INJURY CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. J GREGORY BANCROFT D.P.M. (PODIATRIST)
(215) 222-2225
Entity
Organization
Contact information
Practice address
4014 LANCASTER AVE # A, PHILADELPHIA, PA 19104-1712
(215) 222-2225
(215) 222-3070
Mailing address
4014 LANCASTER AVE # A, PHILADELPHIA, PA 19104-1712
(215) 222-2225
(215) 222-3070
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
SC-001795-L
PA
Other
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
Enumeration date
01/09/2007
Last updated
08/22/2020
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