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General NPI Number Information
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NPI Number | 1740690874
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Entity Type | Organization
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Legal Business Name | ADVANCE FOOT CARE, LLC
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Dates
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Enumeration Date | 04/28/2014
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Last Update Date | 07/09/2014
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Provider Practice Location Address
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Address Line | 192 BRANCH BROOK DR
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City | BELLEVILLE
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State | NJ
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Zip | 07109-3607
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Country | US
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Telephone | 347-350-3802
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Fax | 973-528-8088
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Provider Business Mailing Address
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Address Line | 192 BRANCH BROOK DR
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City | BELLEVILLE
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State | NJ
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Zip | 07109-3607
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Country | US
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Telephone | 347-350-3802
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Fax |
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. ANTONIOUS W ESKANDAR
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Credential | DPM
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Telephone | 347-350-3802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 25MD00319100
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License Number State | NJ
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