Provider Demographics
NPI:1275810343
Name:JSY ENGLEWOOD FOOT & ANKLE CENTER PC
Entity Type:Organization
Organization Name:JSY ENGLEWOOD FOOT & ANKLE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOON
Authorized Official - Middle Name:O
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-227-0900
Mailing Address - Street 1:15 ENGLE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2920
Mailing Address - Country:US
Mailing Address - Phone:201-227-0900
Mailing Address - Fax:201-227-0903
Practice Address - Street 1:15 ENGLE ST STE 202
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2920
Practice Address - Country:US
Practice Address - Phone:201-227-0900
Practice Address - Fax:201-227-0903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty