Provider Demographics
NPI:1386087997
Name:MAIN FOOT AND ANKLE CLINIC LLC
Entity type:Organization
Organization Name:MAIN FOOT AND ANKLE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALMUTASEMB
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEHADA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:1718-986-0781
Mailing Address - Street 1:1040 MAIN ST
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-2212
Mailing Address - Country:US
Mailing Address - Phone:171-898-6078
Mailing Address - Fax:
Practice Address - Street 1:1040 MAIN ST
Practice Address - Street 2:FLOOR 2
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2212
Practice Address - Country:US
Practice Address - Phone:171-898-6078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty