Provider Demographics
NPI:1083629950
Name:REGIONAL FOOT AND ANKLE SPECIALISTS, LLC
Entity Type:Organization
Organization Name:REGIONAL FOOT AND ANKLE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIRARCHI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-875-8855
Mailing Address - Street 1:188 FRIES MILL RD STE F1
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2015
Mailing Address - Country:US
Mailing Address - Phone:856-875-8855
Mailing Address - Fax:856-728-5497
Practice Address - Street 1:188 FRIES MILL RD STE F1
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2015
Practice Address - Country:US
Practice Address - Phone:856-875-8855
Practice Address - Fax:856-728-5497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD001883213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010997230001Medicaid
NJ2188309Medicaid
PA0010997230001Medicaid
PAT30373Medicare UPIN
PA098415Medicare ID - Type UnspecifiedPA GROUP MEDICARE
NJ099613Medicare ID - Type UnspecifiedNJ GROUP MEDICARE
NJ5604330001Medicare NSC