Healthcare Provider Details

I. General information

NPI: 1457502973
Provider Name (Legal Business Name): ANKLE & FOOT HEALTH & TRAUMA INSTITUTE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 KINDERKAMACK RD
EMERSON NJ
07630-1870
US

IV. Provider business mailing address

99 KINDERKAMACK RD
EMERSON NJ
07630-1870
US

V. Phone/Fax

Practice location:
  • Phone: 201-522-3205
  • Fax:
Mailing address:
  • Phone: 201-522-3205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00203200
License Number StateNJ

VIII. Authorized Official

Name: DR. CARNIG C SHAKARJIAN
Title or Position: PHYSICIAN
Credential: DPM
Phone: 201-986-1633