Provider Demographics
NPI:1922392729
Name:A&E ADVANCED FOOT AND ANKLE CARE, LLC
Entity Type:Organization
Organization Name:A&E ADVANCED FOOT AND ANKLE CARE, LLC
Other - Org Name:LUCIANO FOOT DOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YOKAIRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESPIRITUSANTO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:917-592-0651
Mailing Address - Street 1:159 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4511
Mailing Address - Country:US
Mailing Address - Phone:917-592-0651
Mailing Address - Fax:
Practice Address - Street 1:916 MAIN AVE STE 2A
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-8545
Practice Address - Country:US
Practice Address - Phone:973-495-3338
Practice Address - Fax:973-246-5765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00306600213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty