Provider Demographics
NPI:1720676208
Name:ANKLE & FOOT PODIATRY INSTITUTE, PA
Entity Type:Organization
Organization Name:ANKLE & FOOT PODIATRY INSTITUTE, PA
Other - Org Name:FORT LEE PODIATRY, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-224-5790
Mailing Address - Street 1:1625 ANDERSON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2748
Mailing Address - Country:US
Mailing Address - Phone:201-224-5790
Mailing Address - Fax:201-224-5793
Practice Address - Street 1:1625 ANDERSON AVE STE 101
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2748
Practice Address - Country:US
Practice Address - Phone:201-224-5790
Practice Address - Fax:201-224-5793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-09
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty