Provider Demographics
NPI:1619922259
Name:FOOT & ANKLE ASSOCIATES DRS LISS & MIRKIN PA
Entity Type:Organization
Organization Name:FOOT & ANKLE ASSOCIATES DRS LISS & MIRKIN PA
Other - Org Name:KENSINGTON SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MIRKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-969-2000
Mailing Address - Street 1:10901 CONNECTICUT AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895
Mailing Address - Country:US
Mailing Address - Phone:301-949-2000
Mailing Address - Fax:301-949-2002
Practice Address - Street 1:10901 CONNECTICUT AVE
Practice Address - Street 2:STE 200
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895
Practice Address - Country:US
Practice Address - Phone:301-949-2000
Practice Address - Fax:301-949-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1081213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
309467Medicare ID - Type Unspecified
227957Medicare UPIN