Healthcare Provider Details

I. General information

NPI: 1669274973
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: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4503 ATLANTIC AVE
ATLANTIC CITY NJ
08401-5733
US

IV. Provider business mailing address

100 FRONT ST STE 970
CONSHOHOCKEN PA
19428-2800
US

V. Phone/Fax

Practice location:
  • Phone: 609-344-3900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
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