Provider Demographics
NPI:1619450350
Name:ELITE TRI-STATE FOOT CARE, PC
Entity Type:Organization
Organization Name:ELITE TRI-STATE FOOT CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ATTANASIO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-835-8524
Mailing Address - Street 1:62 GLENMARY AVE
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-6259
Mailing Address - Country:US
Mailing Address - Phone:732-835-8524
Mailing Address - Fax:
Practice Address - Street 1:62 GLENMARY AVE
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-6259
Practice Address - Country:US
Practice Address - Phone:732-835-8524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty