Pocono Podiatry and Wound Care, LLC.

Primary specialty

Foot Surgery PodiatristTaxonomy code 213ES0131X

License

SC005819 Issued in PA

Legal business name

POCONO PODIATRY AND WOUND CARE, LLC.

Practice address

296 E Brown St
Suite B
East Stroudsburg, PA 18301-3011

Phone

(215) 681-8057

NPI assigned

Jul 9, 2009

Last updated

Aug 23, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Tanjila Matin, DPMNPI 1518911049

Title

Owner

Phone

(570) 431-0788

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tanjila Matin, DPM

  • Podiatrist
  • East Stroudsburg, PA
  • NPI 1518911049
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282521600000",
    "number": "1326277492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "296 E BROWN ST",
            "address_2": "SUITE B",
            "city": "EAST STROUDSBURG",
            "state": "PA",
            "postal_code": "183013011",
            "telephone_number": "570-431-0788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "296 E BROWN ST",
            "address_2": "SUITE B",
            "city": "EAST STROUDSBURG",
            "state": "PA",
            "postal_code": "183013011",
            "telephone_number": "215-681-8057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POCONO PODIATRY AND WOUND CARE, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-09",
        "last_updated": "2010-08-23",
        "status": "A",
        "authorized_official_last_name": "MATIN",
        "authorized_official_first_name": "TANJILA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "570-431-0788",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "PA",
            "license": "SC005819",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101945964",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pocono Neurology Associates
• Pocono Orthopaedics Surgery
• Pocono Orthopedic Consultants, Inc
• Pocono Orthpopaedics Surgery
• Pocono Pediatric Associates Inc
• Pocono Podiatry Associates
• Pocono Psychiatric Associates
• Pocono Rehab & Therapy Ctr, LLC
• Pocono Surgical Associates
• Pocono Tranquil Gardens, LLC

• Foot Surgery Podiatrist in East Stroudsburg, PA
• Providers in East Stroudsburg, PA by specialty
• Foot Surgery Podiatrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.