Provider Demographics
NPI:1649674334
Name:REGIONAL FOOT AND ANKLE SPECIALISTS
Entity type:Organization
Organization Name:REGIONAL FOOT AND ANKLE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRANTAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-875-8855
Mailing Address - Street 1:188 FRIES MILL RD
Mailing Address - Street 2:SUITE N2
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2015
Mailing Address - Country:US
Mailing Address - Phone:856-875-8855
Mailing Address - Fax:856-728-5497
Practice Address - Street 1:188 FRIES MILL RD
Practice Address - Street 2:SUITE N2
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2015
Practice Address - Country:US
Practice Address - Phone:856-875-8855
Practice Address - Fax:856-728-5497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00171400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty