Provider Demographics
NPI:1083105548
Name:FOOT AND ANKLE PREMIER SPECIALISTS LLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE PREMIER SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATERNINA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-659-5222
Mailing Address - Street 1:70 HUDSON ST BSMT
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5630
Mailing Address - Country:US
Mailing Address - Phone:201-659-5222
Mailing Address - Fax:201-659-0847
Practice Address - Street 1:70 HUDSON ST BSMT
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030
Practice Address - Country:US
Practice Address - Phone:201-659-5222
Practice Address - Fax:201-659-0847
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00333600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1780055137Medicaid