Provider Demographics
NPI:1245424407
Name:ALLSTAR FOOT & ANKLE LLC
Entity Type:Organization
Organization Name:ALLSTAR FOOT & ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDOLF
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-983-0900
Mailing Address - Street 1:9001 LINCOLN DR W STE G
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3202
Mailing Address - Country:US
Mailing Address - Phone:856-983-0900
Mailing Address - Fax:856-983-0905
Practice Address - Street 1:9001 LINCOLN DR W STE G
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3202
Practice Address - Country:US
Practice Address - Phone:856-983-0900
Practice Address - Fax:856-983-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00278000213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ100951Medicaid
NJ5960990001Medicare NSC
V04898Medicare UPIN
NJ100951Medicaid