Provider Demographics
NPI:1275914277
Name:CONCORDIA FOOT AND ANKLE, LLC
Entity Type:Organization
Organization Name:CONCORDIA FOOT AND ANKLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-655-8200
Mailing Address - Street 1:1600 PERRINEVILLE RD
Mailing Address - Street 2:SUITE 24
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-4923
Mailing Address - Country:US
Mailing Address - Phone:609-655-8200
Mailing Address - Fax:609-655-8892
Practice Address - Street 1:1600 PERRINEVILLE RD
Practice Address - Street 2:SUITE 24
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-4923
Practice Address - Country:US
Practice Address - Phone:609-655-8200
Practice Address - Fax:609-655-8892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD003196000213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty