Provider Demographics
NPI:1447432679
Name:EAST ORANGE FOOT AND ANKLE CENTER LLC
Entity Type:Organization
Organization Name:EAST ORANGE FOOT AND ANKLE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:646-505-8203
Mailing Address - Street 1:85 S HARRISON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1700
Mailing Address - Country:US
Mailing Address - Phone:973-678-1303
Mailing Address - Fax:973-678-1306
Practice Address - Street 1:85 S HARRISON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1700
Practice Address - Country:US
Practice Address - Phone:973-678-1303
Practice Address - Fax:973-678-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00294200213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty