Provider Demographics
NPI:1609544246
Name:COMPREHENSIVE FOOT AND ANKLE CARE, LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE FOOT AND ANKLE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST / MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIREILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCHETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:908-793-8454
Mailing Address - Street 1:1156 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2906
Mailing Address - Country:US
Mailing Address - Phone:908-793-8454
Mailing Address - Fax:908-325-0040
Practice Address - Street 1:1156 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2906
Practice Address - Country:US
Practice Address - Phone:908-793-8454
Practice Address - Fax:908-325-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric