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General NPI Number Information
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NPI Number | 1932686334
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Entity Type | Organization
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Legal Business Name | KINETIC FOOT AND ANKLE, LLC
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Dates
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Enumeration Date | 07/27/2018
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Last Update Date | 12/17/2018
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Provider Practice Location Address
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Address Line | 1030 MCBRIDE AVE UNIT 103
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City | WOODLAND PARK
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State | NJ
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Zip | 07424-2535
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Country | US
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Telephone | 862-520-8895
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Fax |
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Provider Business Mailing Address
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Address Line | 50 LINCOLN AVE
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City | LITTLE FALLS
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State | NJ
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Zip | 07424-1535
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Country | US
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Telephone | 862-520-8895
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICO MIGUEL ALMAZAN VISPERAS
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Credential | D.P.M.
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Telephone | 862-520-8895
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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 | 25MD00323600
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License Number State | NJ
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