Provider Demographics
NPI:1578698189
Name:HOLLYWOOD FOOT & ANKLE CENTER INC
Entity Type:Organization
Organization Name:HOLLYWOOD FOOT & ANKLE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MERENDINO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-707-5636
Mailing Address - Street 1:22023 STATE ROAD 7
Mailing Address - Street 2:SUITE #101
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-3401
Mailing Address - Country:US
Mailing Address - Phone:561-353-3333
Mailing Address - Fax:
Practice Address - Street 1:22023 STATE ROAD 7
Practice Address - Street 2:SUITE #101
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-3401
Practice Address - Country:US
Practice Address - Phone:561-353-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2534213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCJ9689OtherRAILROAD MEDICARE
FLK9069Medicare ID - Type Unspecified