Provider Demographics
NPI:1689915068
Name:PREMIERE FOOT AND ANKLE PC
Entity Type:Organization
Organization Name:PREMIERE FOOT AND ANKLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLOSOV
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:908-421-4545
Mailing Address - Street 1:444 PERRY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-5801
Mailing Address - Country:US
Mailing Address - Phone:908-421-4545
Mailing Address - Fax:732-545-2880
Practice Address - Street 1:1527 STATE HIGHWAY 27
Practice Address - Street 2:SUITE 1100
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08827
Practice Address - Country:US
Practice Address - Phone:908-421-4545
Practice Address - Fax:732-545-2880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00311000213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty