Provider Demographics
NPI:1063145894
Name:PODIATRY & ANKLE CENTER OF EXCELLENCE, LLC
Entity type:Organization
Organization Name:PODIATRY & ANKLE CENTER OF EXCELLENCE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARNI
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-978-2700
Mailing Address - Street 1:27 CELLER RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2971
Mailing Address - Country:US
Mailing Address - Phone:201-674-8000
Mailing Address - Fax:
Practice Address - Street 1:59 VERONICA AVE STE 204
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3579
Practice Address - Country:US
Practice Address - Phone:732-978-2700
Practice Address - Fax:833-471-4443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-08
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty