Provider Demographics
NPI:1467736207
Name:ADVANCE ANKLE, FOOT AND PAIN
Entity Type:Organization
Organization Name:ADVANCE ANKLE, FOOT AND PAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBERS/MANAGERS
Authorized Official - Prefix:
Authorized Official - First Name:MIRZA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-473-4040
Mailing Address - Street 1:1084 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2330
Mailing Address - Country:US
Mailing Address - Phone:973-473-4040
Mailing Address - Fax:973-472-2451
Practice Address - Street 1:1084 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2330
Practice Address - Country:US
Practice Address - Phone:973-473-4040
Practice Address - Fax:973-472-2451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ111NN0400X, 174400000X, 2084N0400X, 208VP0000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Multi-Specialty