Provider Demographics
NPI:1376740902
Name:PREMIER FOOT AND ANKLE, INC.
Entity Type:Organization
Organization Name:PREMIER FOOT AND ANKLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:PELOSI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-881-2525
Mailing Address - Street 1:411 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-1633
Mailing Address - Country:US
Mailing Address - Phone:856-881-2525
Mailing Address - Fax:856-881-0734
Practice Address - Street 1:411 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-1633
Practice Address - Country:US
Practice Address - Phone:856-881-2525
Practice Address - Fax:856-881-0734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8622001Medicaid
NJ5083200001Medicare NSC
NJ8622001Medicaid
NJU85865Medicare UPIN