Healthcare Provider Details

I. General information

NPI: 1407943640
Provider Name (Legal Business Name): HACKENSACK QUALITY FOOT CARE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CLINTON PL
HACKENSACK NJ
07601-4579
US

IV. Provider business mailing address

50 CLINTON PL
HACKENSACK NJ
07601-4579
US

V. Phone/Fax

Practice location:
  • Phone: 201-487-4443
  • Fax: 201-487-0065
Mailing address:
  • Phone: 201-487-4443
  • Fax: 201-487-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMD001801
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMD02077
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6775900
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: DR. MARC BOZZETTI
Title or Position: PARTNER/VICE PRESIDENT
Credential: DPM
Phone: 201-487-4443