Healthcare Provider Details

I. General information

NPI: 1497511570
Provider Name (Legal Business Name): INTEGRATED FOOT AND ANKLE SPECIALISTS OF NJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SHORE RD
SOMERS POINT NJ
08244-2630
US

IV. Provider business mailing address

50 S 16TH ST FL 17
PHILADELPHIA PA
19102-3530
US

V. Phone/Fax

Practice location:
  • Phone: 609-927-4894
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TERESA LEONARDA CIACCIO
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 516-993-8666