Provider Demographics
NPI:1477725281
Name:NORTH JERSEY FOOT & ANKLE CENTER
Entity Type:Organization
Organization Name:NORTH JERSEY FOOT & ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:N
Authorized Official - Last Name:NATHANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-784-1900
Mailing Address - Street 1:277 CLOSTER DOCK RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-2445
Mailing Address - Country:US
Mailing Address - Phone:201-784-1900
Mailing Address - Fax:
Practice Address - Street 1:277 CLOSTER DOCK RD
Practice Address - Street 2:SUITE 5
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-2445
Practice Address - Country:US
Practice Address - Phone:201-784-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2210213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU43809Medicare UPIN
NJ122520Medicare PIN