Healthcare Provider Details

I. General information

NPI: 1225810435
Provider Name (Legal Business Name): MONTCLAIR FOOT AND ANKLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 VALLEY RD STE 101
MONTCLAIR NJ
07043-1871
US

IV. Provider business mailing address

546 VALLEY RD STE 101
MONTCLAIR NJ
07043-1871
US

V. Phone/Fax

Practice location:
  • Phone: 973-420-6502
  • Fax:
Mailing address:
  • Phone: 973-265-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. ANISSA HASHEMI-AWWAL
Title or Position: OWNER
Credential: DPM
Phone: 973-265-0888