Provider Demographics
NPI:1518364611
Name:INGROWN NAIL SPECIALISTS, LLC
Entity Type:Organization
Organization Name:INGROWN NAIL SPECIALISTS, LLC
Other - Org Name:INGROWN NAIL DOCS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUST
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:386-274-3336
Mailing Address - Street 1:55 W CHURCH ST
Mailing Address - Street 2:APT. 2601
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-4931
Mailing Address - Country:US
Mailing Address - Phone:561-504-2197
Mailing Address - Fax:
Practice Address - Street 1:8554 PALM PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-6432
Practice Address - Country:US
Practice Address - Phone:386-274-3336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1823213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty