Provider Demographics
NPI:1336154152
Name:A CENTER FOR FOOT AND ANKLE SURGERY PA
Entity type:Organization
Organization Name:A CENTER FOR FOOT AND ANKLE SURGERY PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-427-6800
Mailing Address - Street 1:104 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-1436
Mailing Address - Country:US
Mailing Address - Phone:973-427-6800
Mailing Address - Fax:973-427-9602
Practice Address - Street 1:104 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-1436
Practice Address - Country:US
Practice Address - Phone:973-427-6800
Practice Address - Fax:973-427-9602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJN/A261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6817700Medicaid
NJ490003450OtherRAILROAD MEDICARE
NJ6817700Medicaid