Provider Demographics
NPI:1902208044
Name:HIGH PERFORMANCE FOOT AND ANKLE, LLC
Entity Type:Organization
Organization Name:HIGH PERFORMANCE FOOT AND ANKLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:ALANA
Authorized Official - Last Name:PAUKOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-330-0924
Mailing Address - Street 1:1903 ATLANTIC AVE
Mailing Address - Street 2:BLDG C, STE 3
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1005
Mailing Address - Country:US
Mailing Address - Phone:732-528-2218
Mailing Address - Fax:732-528-2234
Practice Address - Street 1:1903 ATLANTIC AVE
Practice Address - Street 2:BLDG C, STE 3
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1005
Practice Address - Country:US
Practice Address - Phone:732-528-2218
Practice Address - Fax:732-528-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00269900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ402832Medicare PIN