Provider Demographics
NPI:1194118851
Name:EAST BAY FOOT & ANKLE CLINIC INC
Entity type:Organization
Organization Name:EAST BAY FOOT & ANKLE CLINIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:TERNUS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:510-351-7552
Mailing Address - Street 1:13847 E 14TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2626
Mailing Address - Country:US
Mailing Address - Phone:510-351-7552
Mailing Address - Fax:510-351-6009
Practice Address - Street 1:13847 E 14TH ST STE 210
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2626
Practice Address - Country:US
Practice Address - Phone:510-351-7552
Practice Address - Fax:510-351-6009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty