Provider Demographics
NPI:1801545306
Name:GOOD SOLE PODIATRY
Entity type:Organization
Organization Name:GOOD SOLE PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BORYS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-393-4503
Mailing Address - Street 1:1525 OREGON PIKE STE 1201
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4375
Mailing Address - Country:US
Mailing Address - Phone:717-393-4503
Mailing Address - Fax:717-393-5524
Practice Address - Street 1:1525 OREGON PIKE STE 1201
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4375
Practice Address - Country:US
Practice Address - Phone:717-393-4503
Practice Address - Fax:717-393-5524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty