MEDICARE: PREMIER LOWER LIMB CLINIC CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1598540155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER LOWER LIMB CLINIC CORP

Provider Business Mailing Address
First Line	:	2761 JOHN F KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-5515
Country	:	US
Telephone Number	:	201-707-1378
Fax Number	:	682-316-9141

Provider Business Practice Location Address
First Line	:	2761 JOHN F KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-5515
Country	:	US
Telephone Number	:	201-707-1378
Fax Number	:	682-316-9141

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IBRAHIM ELKATTAWY
Credential	:	DPM
Telephone Number	:	201-707-1378

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	08/31/2025

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