Provider Demographics
NPI:1306034350
Name:NEW JERSEY FOOT AND ANKLE
Entity type:Organization
Organization Name:NEW JERSEY FOOT AND ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAUPTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-966-1200
Mailing Address - Street 1:256 COLUMBIA TPKE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1209
Mailing Address - Country:US
Mailing Address - Phone:973-966-1200
Mailing Address - Fax:
Practice Address - Street 1:256 COLUMBIA TPKE
Practice Address - Street 2:SUITE 203
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1209
Practice Address - Country:US
Practice Address - Phone:973-966-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD001125213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty