Provider Demographics
NPI:1225489628
Name:NORTH JERSEY PODIATRY SPECIALISTS LLC
Entity Type:Organization
Organization Name:NORTH JERSEY PODIATRY SPECIALISTS LLC
Other - Org Name:EDGE FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTZIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-255-4040
Mailing Address - Street 1:PO BOX 625
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-0625
Mailing Address - Country:US
Mailing Address - Phone:201-255-4040
Mailing Address - Fax:201-255-4023
Practice Address - Street 1:80 E RTE 4 STE 100
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2647
Practice Address - Country:US
Practice Address - Phone:201-255-4040
Practice Address - Fax:201-255-4023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00331900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI20160622001502Medicare Oscar/Certification