NPIMap

Organization Active NPI

Gordon Podiatry, LLC

  • Podiatrist
  • Glenside, PA
National Provider Identifier
1609311034
Registry record updated Dec 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
SC006606 Issued in PA
Legal business name
GORDON PODIATRY, LLC
Practice address
2285 Cross Rd
Glenside, PA 19038-5023
Phone
(215) 887-5910
Fax
(215) 887-0387
NPI assigned
Dec 20, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2016

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

Authorized official

Name
Dr. Alicia Anne Canzanese, DPMNPI 1710321823
Title
Owner
Phone
(215) 887-5910

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X SC006606 PA Primary

Addresses

Primary practice location

2285 Cross Rd
Glenside, PA 19038-5023

Mailing address

2285 Cross Rd
Glenside, PA 19038-5023
Phone (215) 887-5910

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170424000299 PA Part B Supplier - Clinic/Group Practice 3476839671 Receives reassigned benefits from 4 practitioners
Practice locations: Glenside, PA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1482192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482796800000",
    "number": "1609311034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2285 CROSS RD",
            "city": "GLENSIDE",
            "state": "PA",
            "postal_code": "190385023",
            "telephone_number": "215-887-5910",
            "fax_number": "215-887-0387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2285 CROSS RD",
            "city": "GLENSIDE",
            "state": "PA",
            "postal_code": "190385023",
            "telephone_number": "215-887-5910",
            "fax_number": "215-887-0387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GORDON PODIATRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-20",
        "last_updated": "2016-12-27",
        "status": "A",
        "authorized_official_last_name": "CANZANESE",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "215-887-5910",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "PA",
            "license": "SC006606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenside, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2016; 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.