Individual
LARRY W MENACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2416 E ALLEGHENY AVE, PHILADELPHIA, PA 19134-4403
(215) 843-2330
(215) 848-6760
Mailing address
2416 E ALLEGHENY AVE, PHILADELPHIA, PA 19134-4403
(215) 843-2330
(215) 848-6760
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
MD1184
NJ
213E00000X
Podiatrist
Primary
SC001941L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016086790004
—
PA
Enumeration date
04/25/2006
Last updated
03/25/2010
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