Provider Demographics
NPI:1538308952
Name:AFFILIATED FOOT & ANKLE SPEC OF TEANECK
Entity Type:Organization
Organization Name:AFFILIATED FOOT & ANKLE SPEC OF TEANECK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-238-1595
Mailing Address - Street 1:751 TEANECK RD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-0000
Mailing Address - Country:US
Mailing Address - Phone:201-238-1595
Mailing Address - Fax:201-221-8762
Practice Address - Street 1:751 TEANECK RD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-0000
Practice Address - Country:US
Practice Address - Phone:201-238-1595
Practice Address - Fax:201-221-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00120300213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty