Healthcare Provider Details

I. General information

NPI: 1518430156
Provider Name (Legal Business Name): NEW HAMPSHIRE FOOT AND ANKLE SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BUTTRICK RD STE D1
LONDONDERRY NH
03053-3353
US

IV. Provider business mailing address

25 BUTTRICK RD STE D1
LONDONDERRY NH
03053-3353
US

V. Phone/Fax

Practice location:
  • Phone: 603-216-2972
  • Fax:
Mailing address:
  • Phone: 603-216-2972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: PASQUALE CANCELLIERE
Title or Position: PROVIDER
Credential:
Phone: 978-810-5425