1447432679 NPI number — EAST ORANGE FOOT AND ANKLE CENTER LLC

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 1447432679 NPI number — EAST ORANGE FOOT AND ANKLE CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST ORANGE FOOT AND ANKLE CENTER LLC
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:
1447432679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 CHRISTOPHER COLUMBUS DR STE 404
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JERSEY CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07302-3551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-678-1303
Provider Business Mailing Address Fax Number:
973-678-1306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 GRAVESEND NECK RD # 1A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-4256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-729-0067
Provider Business Practice Location Address Fax Number:
973-678-1306
Provider Enumeration Date:
11/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REYNOLDS
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
KEITH
Authorized Official Title or Position:
PODIATRIST
Authorized Official Telephone Number:
646-505-8203

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  25MD00294200 , 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)





Copyright © 2007-2025 www.npivalidator.com