Provider Demographics
NPI:1740690874
Name:ADVANCE FOOT CARE, LLC
Entity type:Organization
Organization Name:ADVANCE FOOT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIOUS
Authorized Official - Middle Name:W
Authorized Official - Last Name:ESKANDAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:347-350-3802
Mailing Address - Street 1:192 BRANCH BROOK DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3607
Mailing Address - Country:US
Mailing Address - Phone:347-350-3802
Mailing Address - Fax:
Practice Address - Street 1:192 BRANCH BROOK DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3607
Practice Address - Country:US
Practice Address - Phone:347-350-3802
Practice Address - Fax:973-528-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00319100213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty