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General NPI Number Information
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NPI Number | 1972761435
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Entity Type | Organization
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Legal Business Name | ANKLE & FOOT SURGERY, PA
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 11/04/2014
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Provider Practice Location Address
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Address Line | 16 POCONO RD SUITE 209
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City | DENVILLE
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State | NJ
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Zip | 07834-2901
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Country | US
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Telephone | 973-331-7900
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Fax | 973-331-7999
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Provider Business Mailing Address
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Address Line | 16 POCONO RD SUITE 209
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City | DENVILLE
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State | NJ
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Zip | 07834-2901
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Country | US
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Telephone | 973-331-7900
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Fax | 973-331-7999
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. DEAN PETER LICOPANTIS
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Credential | DPM
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Telephone | 973-331-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 25MD00187700
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License Number State | NJ
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