Provider Demographics
NPI:1801274188
Name:FOOT AND ANKLE INSTITUTE OF EDISON, LLC
Entity type:Organization
Organization Name:FOOT AND ANKLE INSTITUTE OF EDISON, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VARUN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUJRAL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-662-3050
Mailing Address - Street 1:2163 OAK TREE RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1083
Mailing Address - Country:US
Mailing Address - Phone:732-662-3050
Mailing Address - Fax:
Practice Address - Street 1:2163 OAK TREE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1083
Practice Address - Country:US
Practice Address - Phone:732-662-3050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW JERSEY PODIATRIC PHYSICIAN AND SURGEON GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00289700213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0154342Medicaid
NJ117909YV3GMedicare PIN