Healthcare Provider Details

I. General information

NPI: 1033556626
Provider Name (Legal Business Name): COMPLETE FOOT AND ANKLE - MALO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 ROUTE 17 11TH FLOOR
RUTHERFORD NJ
07070-2574
US

IV. Provider business mailing address

201 ROUTE 17 11TH FLOOR
RUTHERFORD NJ
07070-2574
US

V. Phone/Fax

Practice location:
  • Phone: 201-445-2288
  • Fax:
Mailing address:
  • Phone: 201-445-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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