Provider Demographics
NPI:1558678102
Name:COMPLETE FOOT AND ANKLE ASSOCIATES OF NORTHERN NEW JERSEY LLC
Entity Type:Organization
Organization Name:COMPLETE FOOT AND ANKLE ASSOCIATES OF NORTHERN NEW JERSEY LLC
Other - Org Name:COMPLETE FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:REINKRAUT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-445-2288
Mailing Address - Street 1:706 CLOVE LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-2238
Mailing Address - Country:US
Mailing Address - Phone:201-774-5756
Mailing Address - Fax:201-891-6364
Practice Address - Street 1:127 UNION ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4478
Practice Address - Country:US
Practice Address - Phone:201-445-2288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00298000213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty