Provider Demographics
NPI:1235375528
Name:FOOT AND ANKLE CENTER LLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TSYGANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-272-1450
Mailing Address - Street 1:3069 ENGLISH CREEK AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-9708
Mailing Address - Country:US
Mailing Address - Phone:609-272-1450
Mailing Address - Fax:
Practice Address - Street 1:3069 ENGLISH CREEK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-9708
Practice Address - Country:US
Practice Address - Phone:609-272-1450
Practice Address - Fax:609-272-1445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00297800261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ149173OtherMEDICARE PTAN
NJ149173OtherMEDICARE PTAN