Healthcare Provider Details

I. General information

NPI: 1437340932
Provider Name (Legal Business Name): PARAMUS FOOT AND ANKLE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W RIDGEWOOD AVE SUITE G1
PARAMUS NJ
07652-2359
US

IV. Provider business mailing address

261 ENGLE ST
TENAFLY NJ
07670-2138
US

V. Phone/Fax

Practice location:
  • Phone: 201-445-4900
  • Fax: 201-568-7567
Mailing address:
  • Phone: 201-568-6977
  • Fax: 201-568-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMD1961
License Number StateNJ

VIII. Authorized Official

Name: DR. JILL HAGEN
Title or Position: PRESIDENT
Credential: DPM
Phone: 201-445-4900