Provider Demographics
NPI:1023469608
Name:NEXT STEP FOOT & ANKLE CENTER, LLC
Entity type:Organization
Organization Name:NEXT STEP FOOT & ANKLE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:FISKE-BAIER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-739-4478
Mailing Address - Street 1:158 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PENNSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18073-1312
Mailing Address - Country:US
Mailing Address - Phone:215-679-5393
Mailing Address - Fax:215-679-9674
Practice Address - Street 1:158 MAIN ST
Practice Address - Street 2:
Practice Address - City:PENNSBURG
Practice Address - State:PA
Practice Address - Zip Code:18073
Practice Address - Country:US
Practice Address - Phone:215-679-5393
Practice Address - Fax:215-679-9674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-25
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031278010004Medicaid