=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518224773
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED FOOT AND ANKLE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2012
-----------------------------------------------------
Last Update Date | 12/13/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 579 CRANBURY RD SUITE G
-----------------------------------------------------
City | EAST BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08816-5405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-979-2035
-----------------------------------------------------
Fax | 732-955-6217
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 579 CRANBURY RD SUITE G
-----------------------------------------------------
City | EAST BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-979-2035
-----------------------------------------------------
Fax | 732-955-6217
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PODIATRIST
-----------------------------------------------------
Name | MRS. CHRISTINE NASHED
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 732-979-2035
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 25MD00310300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------