Healthcare Provider Details

I. General information

NPI: 1871794982
Provider Name (Legal Business Name): HACKENSACK FOOT AND ANKLE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 BERGEN ST SUITE 1
HACKENSACK NJ
07601-5482
US

IV. Provider business mailing address

24 BERGEN ST SUITE 1
HACKENSACK NJ
07601-5482
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-8599
  • Fax: 201-488-4953
Mailing address:
  • Phone: 201-488-8599
  • Fax: 201-488-4953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMD2052
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: LUCY JAKUBOWSKI
Title or Position: OFFICE MANAGER
Credential:
Phone: 201-488-8599