Healthcare Provider Details

I. General information

NPI: 1295030120
Provider Name (Legal Business Name): N & J FOOT AND ANKLE SPECIALIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 29TH AVE NE
NAPLES FL
34120-7432
US

IV. Provider business mailing address

2835 29TH AVE NE
NAPLES FL
34120-7432
US

V. Phone/Fax

Practice location:
  • Phone: 305-305-0847
  • Fax:
Mailing address:
  • Phone: 305-305-0847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3436
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License NumberPO3436
License Number StateFL

VIII. Authorized Official

Name: NIURKA HERRERA
Title or Position: MANAGER
Credential: DPM
Phone: 305-305-0847