Provider Demographics
NPI:1679995351
Name:FOOT AND ANKLE CARE PODIATRY PLLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE CARE PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETERY
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-302-1800
Mailing Address - Street 1:393 TERHUNE AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-2448
Mailing Address - Country:US
Mailing Address - Phone:973-222-3980
Mailing Address - Fax:718-792-5900
Practice Address - Street 1:393 TERHUNE AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-2448
Practice Address - Country:US
Practice Address - Phone:973-222-3980
Practice Address - Fax:718-792-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25MD002213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02891298Medicaid