Organization
PHILADELPHIA PODIATRY GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALFRED J IEZZI JR. DPM (PRESIDENT)
(215) 336-6600
Entity
Organization
Contact information
Practice address
2428 S BROAD ST, PHILA, PA 19145-4418
(215) 336-6600
Mailing address
2428 S BROAD ST, PHILA, PA 19145-4418
(215) 336-6600
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
SC002094L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0687240000
KEYSTONE HMO
PA
Enumeration date
12/15/2006
Last updated
08/22/2020
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