Provider Demographics
NPI:1982103123
Name:ACC PODIATRY, A PODIATRIC CORPORATION
Entity Type:Organization
Organization Name:ACC PODIATRY, A PODIATRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:P
Authorized Official - Last Name:STRAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:510-521-2568
Mailing Address - Street 1:2059 CLINTON AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4379
Mailing Address - Country:US
Mailing Address - Phone:510-521-2568
Mailing Address - Fax:
Practice Address - Street 1:2059 CLINTON AVE STE 1
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4379
Practice Address - Country:US
Practice Address - Phone:510-521-2568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5102213E00000X
CAE3387213E00000X
CAE3305213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty