Healthcare Provider Details

I. General information

NPI: 1225489628
Provider Name (Legal Business Name): NORTH JERSEY PODIATRY SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 E RTE 4 STE 100
PARAMUS NJ
07652-2647
US

IV. Provider business mailing address

PO BOX 625
RIDGEFIELD PARK NJ
07660-0625
US

V. Phone/Fax

Practice location:
  • Phone: 201-255-4040
  • Fax: 201-255-4023
Mailing address:
  • Phone: 201-255-4040
  • Fax: 201-255-4023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00331900
License Number StateNJ

VIII. Authorized Official

Name: DR. GEORGIOS KOTZIAS
Title or Position: PRESIDENT
Credential: DPM
Phone: 201-255-4040