Provider Demographics
NPI:1497057954
Name:FOOT AND ANKLE MEDICAL CLINIC
Entity Type:Organization
Organization Name:FOOT AND ANKLE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REMON
Authorized Official - Middle Name:
Authorized Official - Last Name:GENDY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-907-6210
Mailing Address - Street 1:520 CLIFTON AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-3247
Mailing Address - Country:US
Mailing Address - Phone:973-272-2525
Mailing Address - Fax:973-272-3843
Practice Address - Street 1:520 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-3247
Practice Address - Country:US
Practice Address - Phone:973-272-2525
Practice Address - Fax:973-272-3843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00303800213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6678840001OtherPTAN