Provider Demographics
NPI:1417469503
Name:ANKLE AND FOOT SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:ANKLE AND FOOT SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOTE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:484-470-5736
Mailing Address - Street 1:717 N UNION ST STE 120
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-3031
Mailing Address - Country:US
Mailing Address - Phone:484-470-5736
Mailing Address - Fax:
Practice Address - Street 1:701 N CLAYTON ST STE 400
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3165
Practice Address - Country:US
Practice Address - Phone:484-470-5736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-29
Last Update Date:2017-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0000193213ES0103X
PASC-005870213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty