Provider Demographics
NPI:1629124474
Name:AAL PODIATRY ASSOCIATES PC
Entity Type:Organization
Organization Name:AAL PODIATRY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:N
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-539-2098
Mailing Address - Street 1:2401 GODWIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8178
Mailing Address - Country:US
Mailing Address - Phone:757-539-2098
Mailing Address - Fax:757-539-5188
Practice Address - Street 1:2401 GODWIN BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8178
Practice Address - Country:US
Practice Address - Phone:757-539-2098
Practice Address - Fax:757-539-5188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACD2699Medicare PIN
4395550002Medicare NSC
VAC01174Medicare PIN