Healthcare Provider Details

I. General information

NPI: 1407107170
Provider Name (Legal Business Name): AFFILIATED FOOT & ANKLE SPECIALISTS OF CLIFTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 CLIFTON AVE STE 110
CLIFTON NJ
07013-3517
US

IV. Provider business mailing address

1033 CLIFTON AVE STE 110
CLIFTON NJ
07013-3517
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 TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00120300
License Number StateNJ

VIII. Authorized Official

Name: JEFFREY MILLER
Title or Position: DPM
Credential:
Phone: 973-365-2208