Provider Demographics
NPI:1134102833
Name:FOX MILL FOOT AND ANKLE CENTER PLC
Entity Type:Organization
Organization Name:FOX MILL FOOT AND ANKLE CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUBENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:703-391-0211
Mailing Address - Street 1:1860 TOWN CENTER DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5896
Mailing Address - Country:US
Mailing Address - Phone:703-391-0211
Mailing Address - Fax:703-264-3983
Practice Address - Street 1:1860 TOWN CENTER DR
Practice Address - Street 2:SUITE 220
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5896
Practice Address - Country:US
Practice Address - Phone:703-391-0211
Practice Address - Fax:703-264-3983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00361Medicare ID - Type Unspecified
VA0373560001Medicare NSC