Provider Demographics
NPI:1952469413
Name:INSTITUTE OF FOOT & ANKLE MEDICINE,PC.
Entity Type:Organization
Organization Name:INSTITUTE OF FOOT & ANKLE MEDICINE,PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ENRICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-278-8001
Mailing Address - Street 1:628 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1918
Mailing Address - Country:US
Mailing Address - Phone:973-278-8001
Mailing Address - Fax:973-742-6793
Practice Address - Street 1:628 BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1918
Practice Address - Country:US
Practice Address - Phone:973-278-8001
Practice Address - Fax:973-742-6793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0077046Medicaid
NJ0077046Medicaid
NJT45989Medicare UPIN