Provider Demographics
NPI:1114089679
Name:FOOT AND ANKLE CARE OF PASSAIC LLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE CARE OF PASSAIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROSENBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-246-9420
Mailing Address - Street 1:393 TERHUNE AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-2448
Mailing Address - Country:US
Mailing Address - Phone:973-246-9420
Mailing Address - Fax:718-931-9324
Practice Address - Street 1:393 TERHUNE AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-2448
Practice Address - Country:US
Practice Address - Phone:973-246-9420
Practice Address - Fax:718-261-4220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00278900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ088816Medicare ID - Type Unspecified