| NPI | 1699187096 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY SEIDEL Owner 410-905-5496 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric (Licence: MD 01551) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MD 01551) |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2015-12-10 |