Provider Demographics
NPI:1386162428
Name:ELIZABETH FOOT AND ANKLE ASSOCIATES PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:ELIZABETH FOOT AND ANKLE ASSOCIATES PROFESSIONAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTZIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-310-0954
Mailing Address - Street 1:240 WILLIAMSON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-3671
Mailing Address - Country:US
Mailing Address - Phone:908-353-1777
Mailing Address - Fax:908-355-4400
Practice Address - Street 1:240 WILLIAMSON ST STE 200
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3671
Practice Address - Country:US
Practice Address - Phone:908-353-1777
Practice Address - Fax:908-355-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0557315Medicaid