=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649060195
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOOT CARE CLINIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2025
-----------------------------------------------------
Last Update Date | 05/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 171 RIDGEDALE AVE STE F
-----------------------------------------------------
City | FLORHAM PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07932-1764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-518-1450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31 S HALL CT
-----------------------------------------------------
City | PARSIPPANY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07054-4369
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-518-1450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PODIATRIST
-----------------------------------------------------
Name | DR. MITUL AJVALIA
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 973-518-1450
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------