Provider Demographics
NPI:1194375295
Name:BERKELEY FOOT AND ANKLE PODIATRY GROUP, INC
Entity Type:Organization
Organization Name:BERKELEY FOOT AND ANKLE PODIATRY GROUP, INC
Other - Org Name:BAY AREA FOOT & LASER PODIATRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:HUEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:510-849-3800
Mailing Address - Street 1:3000 COLBY ST STE 104
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2090
Mailing Address - Country:US
Mailing Address - Phone:510-849-3800
Mailing Address - Fax:510-849-3810
Practice Address - Street 1:3000 COLBY ST STE 104
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2090
Practice Address - Country:US
Practice Address - Phone:510-849-3800
Practice Address - Fax:510-849-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty