MEDICARE: FOOT AND ANKLE PREMIER SPECIALISTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083105548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT AND ANKLE PREMIER SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	70 HUDSON ST BSMT
Second Line	:
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-5630
Country	:	US
Telephone Number	:	201-659-5222
Fax Number	:	201-659-0847

Provider Business Practice Location Address
First Line	:	70 HUDSON ST BSMT
Second Line	:
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-5630
Country	:	US
Telephone Number	:	201-659-5222
Fax Number	:	201-659-0847

Authorized Official
Title or Position	:	OWNER
Name	:	JULIANA PATERNINA
Credential	:	DPM
Telephone Number	:	201-659-5222

Provider Enumeration Date	:	05/21/2018
Last Update Date	:	05/19/2026

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