Healthcare Provider Details

I. General information

NPI: 1831995521
Provider Name (Legal Business Name): INTEGRATED FOOT AND ANKLE SPECIALISTS OF NJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2025
Last Update Date: 02/22/2025
Certification Date: 02/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 WHITE HORSE PIKE STE 101
ATCO NJ
08004-2275
US

IV. Provider business mailing address

PO BOX 1038
MARLTON NJ
08053-6038
US

V. Phone/Fax

Practice location:
  • Phone: 856-768-7850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TERESA LEONARDA CIACCIO
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 516-993-8666