Provider Demographics
NPI:1619225661
Name:FOOT AND ANKLE INSTITUTE OF EDISON LLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE INSTITUTE OF EDISON LLC
Other - Org Name:AFFILIATED FOOT AND ANKLE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VARUN
Authorized Official - Middle Name:B
Authorized Official - Last Name:GUJRAL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-662-3050
Mailing Address - Street 1:2163 OAK TREE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1083
Mailing Address - Country:US
Mailing Address - Phone:732-662-3050
Mailing Address - Fax:732-662-3049
Practice Address - Street 1:2163 OAK TREE RD STE 108
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1083
Practice Address - Country:US
Practice Address - Phone:732-662-3050
Practice Address - Fax:732-662-3049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-23
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00289700332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6710480001Medicare NSC