Provider Demographics
NPI:1457502973
Name:ANKLE & FOOT HEALTH & TRAUMA INSTITUTE PA
Entity Type:Organization
Organization Name:ANKLE & FOOT HEALTH & TRAUMA INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CARNIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHAKARJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-986-1633
Mailing Address - Street 1:99 KINDERKAMACK RD
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1870
Mailing Address - Country:US
Mailing Address - Phone:201-522-3205
Mailing Address - Fax:
Practice Address - Street 1:99 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1870
Practice Address - Country:US
Practice Address - Phone:201-522-3205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00203200213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0905270001Medicare NSC