Provider Demographics
NPI:1508130873
Name:NEW JERSEY FOOT AND ANKLE SPECIALISTS LLC
Entity Type:Organization
Organization Name:NEW JERSEY FOOT AND ANKLE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER, MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-981-5250
Mailing Address - Street 1:1700 ROUTE 23 STE 160
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7513
Mailing Address - Country:US
Mailing Address - Phone:973-944-0226
Mailing Address - Fax:973-695-1035
Practice Address - Street 1:1700 ROUTE 23 STE 160
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7513
Practice Address - Country:US
Practice Address - Phone:973-944-0226
Practice Address - Fax:973-695-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00301200213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty