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General NPI Number Information
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NPI Number | 1306290648
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Entity Type | Organization
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Legal Business Name | ACTIVE FOOT AND ANKLE OF CAROLINA PLLC
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Dates
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Enumeration Date | 04/22/2016
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Last Update Date | 04/18/2019
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Provider Practice Location Address
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Address Line | 1076 US HIGHWAY 17 S
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-7627
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Country | US
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Telephone | 252-333-3111
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Fax | 252-333-1105
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Provider Business Mailing Address
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Address Line | 632 CEDAR RD STE B
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City | CHESAPEAKE
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State | VA
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Zip | 23322-8376
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Country | US
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Telephone | 757-547-0123
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Fax | 757-547-2412
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Authorized Official
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Title or Position | OWNER
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Name | DR. MUNJED SALEM
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Credential | DPM
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Telephone | 252-333-3111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 623
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 623
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License Number State | NC
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