Healthcare Provider Details

I. General information

NPI: 1386042877
Provider Name (Legal Business Name): DR AFFAN AKHTAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 HAMBURG TPKE STE 100
WAYNE NJ
07470-5043
US

IV. Provider business mailing address

1211 HAMBURG TPKE STE 100
WAYNE NJ
07470-5043
US

V. Phone/Fax

Practice location:
  • Phone: 973-692-1111
  • Fax:
Mailing address:
  • Phone: 973-692-1111
  • 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: AFFAN AKHTAR
Title or Position: MANAGING MEMBER
Credential: DPM
Phone: 973-692-1111