Provider Demographics
NPI:1700914918
Name:ADVANCED FOOT & ANKLE SPECIALISTS PC
Entity Type:Organization
Organization Name:ADVANCED FOOT & ANKLE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTAVINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-352-2944
Mailing Address - Street 1:61 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3318
Mailing Address - Country:US
Mailing Address - Phone:603-352-2944
Mailing Address - Fax:603-355-2273
Practice Address - Street 1:61 SUMMER ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3318
Practice Address - Country:US
Practice Address - Phone:603-352-2944
Practice Address - Fax:603-355-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0263213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHU43023Medicare UPIN
NH5744220001Medicare NSC
NHRE5629Medicare ID - Type Unspecified