Healthcare Provider Details

I. General information

NPI: 1649775065
Provider Name (Legal Business Name): NJC FOOT & ANKLE SURGICAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2951 NW 49TH AVE STE 201
LAUDERDALE LAKES FL
33313-1608
US

IV. Provider business mailing address

15773 NW 3RD ST
PEMBROKE PINES FL
33028-1588
US

V. Phone/Fax

Practice location:
  • Phone: 305-712-6395
  • Fax: 305-630-8590
Mailing address:
  • Phone: 609-506-8362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS JOSEPH CORETTI III
Title or Position: OWNER/PODIATRISTS
Credential: DPM
Phone: 609-506-8362