1689915068 NPI number — PREMIERE FOOT AND ANKLE PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689915068 NPI number — PREMIERE FOOT AND ANKLE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIERE FOOT AND ANKLE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689915068
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
444 PERRY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH BRUNSWICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08902-5801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-421-4545
Provider Business Mailing Address Fax Number:
732-545-2880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1527 STATE HIGHWAY 27
Provider Second Line Business Practice Location Address:
SUITE 1100
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-421-4545
Provider Business Practice Location Address Fax Number:
732-545-2880
Provider Enumeration Date:
03/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
VOLOSOV
Authorized Official First Name:
ROCHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
908-421-4545

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  25MD00311000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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