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General NPI Number Information
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NPI Number | 1669087748
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Entity Type | Organization
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Legal Business Name | DYNAMIC FOOT & ANKLE
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 602 BLOOMFIELD AVE
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City | WEST CALDWELL
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State | NJ
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Zip | 07006-7503
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Country | US
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Telephone | 973-716-0666
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Fax | 973-366-5925
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Provider Business Mailing Address
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Address Line | 121 CENTER GROVE RD
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City | RANDOLPH
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State | NJ
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Zip | 07869-4453
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Country | US
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Telephone | 973-366-1016
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KAITLIN DICKERT GONZALES
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Credential |
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Telephone | 609-618-7289
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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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