Provider Demographics
NPI:1164621025
Name:COSMETIC FOOT ANKLE & LEG VEIN CENTER LLC
Entity Type:Organization
Organization Name:COSMETIC FOOT ANKLE & LEG VEIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JODI
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHOENHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-750-3033
Mailing Address - Street 1:670 GLADES RD
Mailing Address - Street 2:320
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6464
Mailing Address - Country:US
Mailing Address - Phone:561-750-3033
Mailing Address - Fax:561-750-3443
Practice Address - Street 1:670 GLADES RD
Practice Address - Street 2:320
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6464
Practice Address - Country:US
Practice Address - Phone:561-750-3033
Practice Address - Fax:561-750-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3125213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5522850001Medicare NSC
K9143Medicare PIN