Provider Demographics
NPI:1073929071
Name:SUSSEX FOOT AND ANKLE SPECIALIST,LLC
Entity Type:Organization
Organization Name:SUSSEX FOOT AND ANKLE SPECIALIST,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-409-0123
Mailing Address - Street 1:518 ROUTE 6 AND 209
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-9424
Mailing Address - Country:US
Mailing Address - Phone:570-409-0123
Mailing Address - Fax:855-495-0993
Practice Address - Street 1:110 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-5119
Practice Address - Country:US
Practice Address - Phone:845-343-6050
Practice Address - Fax:855-495-0993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4736220003Medicare NSC