Provider Demographics
NPI:1407911035
Name:PODIATRY FOOT & ANKLE INSTITUTE
Entity Type:Organization
Organization Name:PODIATRY FOOT & ANKLE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:I
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-488-3668
Mailing Address - Street 1:EDWARD I HARRIS
Mailing Address - Street 2:20 PROSPECT AVE STE 803
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1999
Mailing Address - Country:US
Mailing Address - Phone:201-488-3668
Mailing Address - Fax:201-488-9292
Practice Address - Street 1:EDWARD I HARRIS
Practice Address - Street 2:20 PROSPECT AVE STE 803
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1999
Practice Address - Country:US
Practice Address - Phone:201-488-3668
Practice Address - Fax:201-488-9292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ213E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0824330001Medicare NSC