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General NPI Number Information
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NPI Number | 1912369166
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Entity Type | Organization
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Legal Business Name | AT YOUR FEET PODIATRY LLC
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Dates
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Enumeration Date | 03/27/2016
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Last Update Date | 03/27/2016
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Provider Practice Location Address
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Address Line | 387 W BLACKWELL ST
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City | DOVER
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State | NJ
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Zip | 07801-2559
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Country | US
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Telephone | 973-366-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 387 W BLACKWELL ST
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City | DOVER
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State | NJ
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Zip | 07801-2559
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE PROPIETOR
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Name | GRACIANI MARTINEZ
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Credential | D.P.M.
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Telephone | 917-445-4992
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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 | 25MD00276200
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License Number State | NJ
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