Healthcare Provider Details

I. General information

NPI: 1942215579
Provider Name (Legal Business Name): AMBULATORY FOOT AND ANKLE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2059 BRIGGS RD SUITE 308
MOUNT LAUREL NJ
08054-4640
US

IV. Provider business mailing address

2059 BRIGGS RD SUITE 308
MOUNT LAUREL NJ
08054-4640
US

V. Phone/Fax

Practice location:
  • Phone: 856-234-5180
  • Fax: 856-234-3230
Mailing address:
  • Phone: 856-234-5180
  • Fax: 856-234-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00112000
License Number StateNJ

VIII. Authorized Official

Name: DR. HOWARD SANFORD ABRAMSOHN
Title or Position: CEO, PRESIDENT
Credential: D.P.M.
Phone: 856-234-5180