1447221684 NPI number — DRS. LISS & MIRKIN, P.A. T/A FOOT & ANKLE ASSOCIATES

Table of content: (NPI 1447221684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447221684 NPI number — DRS. LISS & MIRKIN, P.A. T/A FOOT & ANKLE ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS. LISS & MIRKIN, P.A. T/A FOOT & ANKLE ASSOCIATES
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:
1447221684
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10901 CONNECTICUT AVE
Provider Second Line Business Mailing Address:
#200
Provider Business Mailing Address City Name:
KENSINGTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20895-1645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-949-2000
Provider Business Mailing Address Fax Number:
301-949-2002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10901 CONNECTICUT AVENUE
Provider Second Line Business Practice Location Address:
#200
Provider Business Practice Location Address City Name:
KENSINGTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20895
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-949-2000
Provider Business Practice Location Address Fax Number:
301-949-2002
Provider Enumeration Date:
01/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MIRKIN
Authorized Official First Name:
GENE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
MEDICAL DIRECTOR OWNER
Authorized Official Telephone Number:
301-949-2000

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  A1081 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 21C0001081 . This is a "HIXA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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