Healthcare Provider Details

I. General information

NPI: 1689915068
Provider Name (Legal Business Name): PREMIERE FOOT AND ANKLE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2013
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 STATE HIGHWAY 27 SUITE 1100
SOMERSET NJ
08827
US

IV. Provider business mailing address

444 PERRY DR
NORTH BRUNSWICK NJ
08902-5801
US

V. Phone/Fax

Practice location:
  • Phone: 908-421-4545
  • Fax: 732-545-2880
Mailing address:
  • Phone: 908-421-4545
  • Fax: 732-545-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00311000
License Number StateNJ

VIII. Authorized Official

Name: DR. ROCHELLE VOLOSOV
Title or Position: PHYSICIAN OWNER
Credential: DPM
Phone: 908-421-4545