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General NPI Number Information
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NPI Number | 1649132234
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Entity Type | Organization
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Legal Business Name | FOOT AND ANKLE HEALTH CENTER OF BLOOMFIELD LLC
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 667 EAGLE ROCK AVE STE B
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City | WEST ORANGE
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State | NJ
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Zip | 07052-2177
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Country | US
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Telephone | 973-736-4030
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Fax |
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Provider Business Mailing Address
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Address Line | 355 TOM HUNTER RD
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City | FORT LEE
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State | NJ
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Zip | 07024-4608
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Country | US
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Telephone | 201-463-0240
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Fax |
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Authorized Official
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Title or Position | PODIATRIST
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Name | CHARLES LEE
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Credential | DPM
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Telephone | 201-463-0240
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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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