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General NPI Number Information
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NPI Number | 1104305754
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Entity Type | Organization
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Legal Business Name | FAIRFAX FOOT AND ANKLE SPECIALISTS, PLLC
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Dates
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Enumeration Date | 08/13/2018
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Last Update Date | 08/13/2018
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Provider Practice Location Address
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Address Line | 10875 MAIN ST STE 212
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City | FAIRFAX
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State | VA
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Zip | 22030-4732
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Country | US
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Telephone | 203-494-6958
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Fax |
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Provider Business Mailing Address
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Address Line | 10875 MAIN ST STE 212
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City | FAIRFAX
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State | VA
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Zip | 22030-4732
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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 | PODIATRIST
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Name | DR. KYLE SCHOLNICK
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Credential | DPM
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Telephone | 203-494-6958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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