Provider Demographics
NPI:1437277522
Name:ADVANCED FOOT AND ANKLE SPECIALISTS PA
Entity Type:Organization
Organization Name:ADVANCED FOOT AND ANKLE SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEINGARTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:772-223-8313
Mailing Address - Street 1:1233 SE INDIAN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-5689
Mailing Address - Country:US
Mailing Address - Phone:772-223-8313
Mailing Address - Fax:772-223-8675
Practice Address - Street 1:1233 SE INDIAN ST STE 102
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-5689
Practice Address - Country:US
Practice Address - Phone:772-223-8313
Practice Address - Fax:772-223-8675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO000220213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDA1737OtherRAILROAD MEDICARE
FL65234OtherBCBS
FL340500100Medicaid
FL10D0725649OtherCLIA
FL1001830001Medicare NSC
FL65234OtherBCBS