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General NPI Number Information
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NPI Number | 1922609916
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Entity Type | Organization
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Legal Business Name | BERGEN RECONSTRUCTIVE FOOT & ANKLE SPECIALISTS LLC
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Dates
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Enumeration Date | 11/05/2020
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Last Update Date | 11/05/2020
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Provider Practice Location Address
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Address Line | 315 ROCHELLE AVE
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City | ROCHELLE PARK
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State | NJ
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Zip | 07662-3916
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Country | US
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Telephone | 201-414-8089
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Fax | 201-843-1036
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Provider Business Mailing Address
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Address Line | 315 ROCHELLE AVE
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City | ROCHELLE PARK
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State | NJ
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Zip | 07662-3916
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Country | US
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Telephone | 201-414-8089
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Fax | 201-843-1036
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Authorized Official
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Title or Position | OWNER
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Name | DANIELLA RENEE MENILLO
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Credential | DPM
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Telephone | 201-414-8089
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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 |
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License Number State |
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