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General NPI Number Information
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NPI Number | 1922392729
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Entity Type | Organization
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Legal Business Name | A&E ADVANCED FOOT AND ANKLE CARE, LLC
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Dates
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Enumeration Date | 06/09/2011
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Last Update Date | 01/04/2017
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Provider Practice Location Address
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Address Line | 916 MAIN AVE STE 2A
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City | PASSAIC
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State | NJ
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Zip | 07055-8545
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Country | US
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Telephone | 973-495-3338
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Fax | 973-246-5765
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Provider Business Mailing Address
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Address Line | 159 HOWARD AVE
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City | PASSAIC
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State | NJ
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Zip | 07055-4511
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Country | US
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Telephone | 917-592-0651
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. YOKAIRA A ESPIRITUSANTO
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Credential | DPM
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Telephone | 917-592-0651
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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 | 25MD00306600
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License Number State | NJ
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