Healthcare Provider Details

I. General information

NPI: 1306034350
Provider Name (Legal Business Name): NEW JERSEY FOOT AND ANKLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 COLUMBIA TPKE SUITE 203
FLORHAM PARK NJ
07932-1209
US

IV. Provider business mailing address

256 COLUMBIA TPKE SUITE 203
FLORHAM PARK NJ
07932-1209
US

V. Phone/Fax

Practice location:
  • Phone: 973-966-1200
  • Fax:
Mailing address:
  • Phone: 973-966-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD001125
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD001125
License Number StateNJ

VIII. Authorized Official

Name: DR. IRA A HAUPTMAN
Title or Position: CEO
Credential: D.P.M.
Phone: 973-966-1200