Healthcare Provider Details

I. General information

NPI: 1912442559
Provider Name (Legal Business Name): AFFILIATED FOOT & ANKLE SPECIALISTS OF CLIFTON, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 ROUTE 46 SUITE 203
CLIFTON NJ
07013-2449
US

IV. Provider business mailing address

1117 ROUTE 46 SUITE 203
CLIFTON NJ
07013-2449
US

V. Phone/Fax

Practice location:
  • Phone: 973-365-2208
  • Fax: 973-777-4895
Mailing address:
  • Phone: 973-365-2208
  • Fax: 973-777-4895

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. JEFFREY MILLER
Title or Position: OWNER
Credential:
Phone: 973-365-2208