Provider Demographics
NPI:1649775065
Name:NJC FOOT & ANKLE SURGICAL SPECIALISTS
Entity Type:Organization
Organization Name:NJC FOOT & ANKLE SURGICAL SPECIALISTS
Other - Org Name:NJC FOOT & ANKLE SURGICAL SPECIALISTS LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PODIATRISTS
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CORETTI
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-506-8362
Mailing Address - Street 1:15773 NW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1588
Mailing Address - Country:US
Mailing Address - Phone:609-506-8362
Mailing Address - Fax:
Practice Address - Street 1:2951 NW 49TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1608
Practice Address - Country:US
Practice Address - Phone:305-712-6395
Practice Address - Fax:305-630-8590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103268900Medicaid
FLN1921OtherMEDICARE
FLJP447OtherMEDICARE MIA