Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | SC002381-L | PA |
NPI | 1184629396 |
---|---|
Provider Name | Dr. Glenn Barry Truskin |
First Address | Philadelphia, PA 19152-2733 |
Second Address | Philadelphia, PA 19152-2733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 24/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0008415800001 | (05) | PA |
T30062 | (02) |