Healthcare Provider Details

I. General information

NPI: 1558678102
Provider Name (Legal Business Name): COMPLETE FOOT AND ANKLE ASSOCIATES OF NORTHERN NEW JERSEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 UNION ST
RIDGEWOOD NJ
07450-4478
US

IV. Provider business mailing address

706 CLOVE LN
FRANKLIN LAKES NJ
07417-2238
US

V. Phone/Fax

Practice location:
  • Phone: 201-445-2288
  • Fax:
Mailing address:
  • Phone: 201-774-5756
  • Fax: 201-891-6364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00298000
License Number StateNJ

VIII. Authorized Official

Name: DR. JACOB REINKRAUT
Title or Position: OWNER
Credential: DPM
Phone: 201-445-2288