=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962090969
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST MILFORD FOOT AND ANKLE SPECIALISTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2021
-----------------------------------------------------
Last Update Date | 10/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1485 UNION VALLEY RD STE C
-----------------------------------------------------
City | WEST MILFORD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07480-1317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-728-2211
-----------------------------------------------------
Fax | 973-728-2237
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1485 UNION VALLEY RD STE C
-----------------------------------------------------
City | WEST MILFORD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07480-1317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-728-2211
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DR. MOHAN MENSAH
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 919-519-8806
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------