Provider Demographics
NPI:1942215579
Name:AMBULATORY FOOT AND ANKLE ASSOCIATES LLC
Entity Type:Organization
Organization Name:AMBULATORY FOOT AND ANKLE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:SANFORD
Authorized Official - Last Name:ABRAMSOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-234-5180
Mailing Address - Street 1:2059 BRIGGS RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-4640
Mailing Address - Country:US
Mailing Address - Phone:856-234-5180
Mailing Address - Fax:856-234-3230
Practice Address - Street 1:2059 BRIGGS RD
Practice Address - Street 2:SUITE 308
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-4640
Practice Address - Country:US
Practice Address - Phone:856-234-5180
Practice Address - Fax:856-234-3230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00112000213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3013103Medicaid
NJ3013103Medicaid
T73081Medicare UPIN