Healthcare Provider Details

I. General information

NPI: 1376740902
Provider Name (Legal Business Name): PREMIER FOOT AND ANKLE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 N MAIN ST
GLASSBORO NJ
08028-1633
US

IV. Provider business mailing address

411 N MAIN ST
GLASSBORO NJ
08028-1633
US

V. Phone/Fax

Practice location:
  • Phone: 856-881-2525
  • Fax: 856-881-0734
Mailing address:
  • Phone: 856-881-2525
  • Fax: 856-881-0734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN E PELOSI
Title or Position: PRESIDENT
Credential: DPM
Phone: 856-881-2525