Provider Demographics
NPI:1609045053
Name:BRIAN A DECHOWITZ DBA PINE STREET PODIATRY
Entity type:Organization
Organization Name:BRIAN A DECHOWITZ DBA PINE STREET PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:DECHOWTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-238-1445
Mailing Address - Street 1:127 PINE STREET
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17101-1240
Mailing Address - Country:US
Mailing Address - Phone:717-238-1445
Mailing Address - Fax:717-238-1446
Practice Address - Street 1:127 PINE STREET
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-1240
Practice Address - Country:US
Practice Address - Phone:717-238-1445
Practice Address - Fax:717-238-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002835L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA126332Medicare PIN
PAT29322Medicare UPIN
PA4767200001Medicare NSC