Provider Demographics
NPI:1396926119
Name:A CENTER FOR FOOT AND ANKLE SURGERY, P.A.
Entity type:Organization
Organization Name:A CENTER FOR FOOT AND ANKLE SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUADARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-854-7585
Mailing Address - Street 1:7521 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5459
Mailing Address - Country:US
Mailing Address - Phone:201-854-7585
Mailing Address - Fax:
Practice Address - Street 1:7521 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5459
Practice Address - Country:US
Practice Address - Phone:201-854-7585
Practice Address - Fax:201-869-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU70854Medicare UPIN
NJ696791Medicare PIN