Provider Demographics
NPI: | 1205387461 |
---|---|
Name: | EMPIRE FOOT AND ANKLE CENTER INC. |
Entity Type: | Organization |
Organization Name: | EMPIRE FOOT AND ANKLE CENTER INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | RABIN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BERAL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DPM |
Authorized Official - Phone: | 310-515-8155 |
Mailing Address - Street 1: | 1141 W REDONDO BEACH BLVD |
Mailing Address - Street 2: | STE 302 |
Mailing Address - City: | GARDENA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90247-3586 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 310-515-8155 |
Mailing Address - Fax: | 310-515-8833 |
Practice Address - Street 1: | 299 W FOOTHILL BLVD |
Practice Address - Street 2: | 124 |
Practice Address - City: | UPLAND |
Practice Address - State: | CA |
Practice Address - Zip Code: | 91786-3804 |
Practice Address - Country: | US |
Practice Address - Phone: | 909-946-6643 |
Practice Address - Fax: | 909-946-6130 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-10-21 |
Last Update Date: | 2017-02-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Single Specialty |