Provider Demographics
NPI:1427833961
Name:PROFESSIONAL FOOT AND ANKLE CARE PC
Entity type:Organization
Organization Name:PROFESSIONAL FOOT AND ANKLE CARE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YAKOV
Authorized Official - Middle Name:
Authorized Official - Last Name:GROYSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-375-4997
Mailing Address - Street 1:195 US HIGHWAY 9 STE 108A
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8119
Mailing Address - Country:US
Mailing Address - Phone:201-375-4997
Mailing Address - Fax:
Practice Address - Street 1:195 US HIGHWAY 9 STE 108A
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8119
Practice Address - Country:US
Practice Address - Phone:201-375-4997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1568950087OtherYAKOV GROYSMAN