Provider Demographics
NPI:1700441748
Name:JOURNAL SQUARE FOOT AND ANKLE CARE LLC
Entity Type:Organization
Organization Name:JOURNAL SQUARE FOOT AND ANKLE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:VISHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GANDHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-356-0990
Mailing Address - Street 1:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-0141
Mailing Address - Country:US
Mailing Address - Phone:201-659-2986
Mailing Address - Fax:201-332-4122
Practice Address - Street 1:377 JERSEY AVE STE 460
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4691
Practice Address - Country:US
Practice Address - Phone:201-659-2986
Practice Address - Fax:201-332-4122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty