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General NPI Number Information
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NPI Number | 1033915723
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Entity Type | Organization
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Legal Business Name | INTEGRATED FOOT AND ANKLE SPECIALISTS OF NJ LLC
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Dates
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Enumeration Date | 02/22/2025
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Last Update Date | 02/22/2025
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Provider Practice Location Address
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Address Line | 2301 E EVESHAM RD STE 207&208
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City | VOORHEES
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State | NJ
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Zip | 08043-4501
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Country | US
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Telephone | 856-768-7850
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1038
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City | MARLTON
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State | NJ
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Zip | 08053-6038
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | TERESA LEONARDA CIACCIO
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Credential |
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Telephone | 516-993-8666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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