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General NPI Number Information
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NPI Number | 1942801584
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Entity Type | Organization
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Legal Business Name | KINETIC EDGE FOOT & ANKLE LLC
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Dates
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Enumeration Date | 11/02/2020
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 379 MAIN AVE STE 3
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City | WALLINGTON
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State | NJ
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Zip | 07057-1829
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Country | US
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Telephone | 201-655-6617
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Fax | 201-655-6618
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Provider Business Mailing Address
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Address Line | 4 QUINE ST
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City | CRANFORD
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State | NJ
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Zip | 07016-3130
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Country | US
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Telephone | 908-499-3956
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Fax | 908-276-8765
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. CHESTER S KLIMEK
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Credential | DPM
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Telephone | 908-873-8171
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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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