Provider Demographics
NPI:1225810435
Name:NJ ANKLE PAIN LLC
Entity Type:Organization
Organization Name:NJ ANKLE PAIN LLC
Other - Org Name:NJ ANKLE PAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASHEMI-AWWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-265-0888
Mailing Address - Street 1:32 BONNIEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:TOWACO
Mailing Address - State:NJ
Mailing Address - Zip Code:07082-1289
Mailing Address - Country:US
Mailing Address - Phone:973-420-6502
Mailing Address - Fax:
Practice Address - Street 1:115 STATE RT 46
Practice Address - Street 2:UNIT B12
Practice Address - City:MOUNTAIN LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07046
Practice Address - Country:US
Practice Address - Phone:973-265-0888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty