Provider Demographics
NPI:1700817186
Name:ACHILLES FOOT AND ANKLE GROUP LLC
Entity Type:Organization
Organization Name:ACHILLES FOOT AND ANKLE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:LEVINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-868-2400
Mailing Address - Street 1:9234 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5312
Mailing Address - Country:US
Mailing Address - Phone:201-868-2400
Mailing Address - Fax:201-868-2014
Practice Address - Street 1:9234 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5312
Practice Address - Country:US
Practice Address - Phone:201-868-2400
Practice Address - Fax:201-868-2014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00105200213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0113310Medicaid
NJ458839Medicare ID - Type Unspecified
NJ5810760001Medicare NSC
NJ0113310Medicaid