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General NPI Number Information
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NPI Number | 1295072627
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Entity Type | Organization
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Legal Business Name | PREMIER FOOT & ANKLE CENTER
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Dates
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Enumeration Date | 01/04/2013
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Last Update Date | 11/16/2016
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Provider Practice Location Address
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Address Line | 7 CEDAR GROVE LN STE 28 SUITE C
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City | SOMERSET
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State | NJ
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Zip | 08873-1331
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Country | US
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Telephone | 732-397-5427
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Fax |
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Provider Business Mailing Address
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Address Line | 7 CEDAR GROVE LN STE 28 SUITE C
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City | SOMERSET
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State | NJ
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Zip | 08873-1331
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Country | US
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Telephone | 732-397-5427
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JADE GITTENS
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Credential | DPM
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Telephone | 732-397-5427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 25MD00309500
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License Number State | NJ
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