Provider Demographics
NPI:1609045079
Name:RAPHA FOOT AND ANKLE CENTER
Entity type:Organization
Organization Name:RAPHA FOOT AND ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONG
Authorized Official - Middle Name:MIN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-289-7007
Mailing Address - Street 1:10 LIBERTE LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5721
Mailing Address - Country:US
Mailing Address - Phone:610-584-4143
Mailing Address - Fax:610-584-4143
Practice Address - Street 1:4605 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-5803
Practice Address - Country:US
Practice Address - Phone:215-289-7007
Practice Address - Fax:215-289-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009302350001Medicaid
PA5288640001OtherMEDICARE NAC (DME)
PA1009302350001Medicaid
PA5288640001OtherMEDICARE NAC (DME)