Provider Demographics
NPI:1184022642
Name:OPTIMAL ANKLE & FOOT LLC
Entity Type:Organization
Organization Name:OPTIMAL ANKLE & FOOT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AFFAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHTAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-692-1111
Mailing Address - Street 1:1211 HAMBURG TPKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5043
Mailing Address - Country:US
Mailing Address - Phone:973-692-1111
Mailing Address - Fax:
Practice Address - Street 1:1211 HAMBURG TPKE
Practice Address - Street 2:SUITE 100
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5043
Practice Address - Country:US
Practice Address - Phone:973-692-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty