Provider Demographics
NPI:1356123293
Name:FOOT AND ANKLE CENTER OF NJ & NY LLC
Entity type:Organization
Organization Name:FOOT AND ANKLE CENTER OF NJ & NY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAVRIIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAIMOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-363-9844
Mailing Address - Street 1:2225 LEMOINE AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6104
Mailing Address - Country:US
Mailing Address - Phone:201-363-9844
Mailing Address - Fax:201-363-9662
Practice Address - Street 1:2225 LEMOINE AVE FL 1
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6104
Practice Address - Country:US
Practice Address - Phone:201-363-9844
Practice Address - Fax:201-363-9662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty