MEDICARE: FORT LEE FOOT AND ANKLE CENTER PC

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	25MD00275000	NJ

General Provider Information

NPI Number	:	1083706386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT LEE FOOT AND ANKLE CENTER PC

Provider Business Mailing Address
First Line	:	162 SIERRA VISTA LN
Second Line	:
City	:	VALLEY COTTAGE
State	:	NY
Zip	:	10989-2702
Country	:	US
Telephone Number	:	845-480-2018
Fax Number	:	201-947-4555

Provider Business Practice Location Address
First Line	:	2247 LEMOINE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6124
Country	:	US
Telephone Number	:	201-947-1758
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. VICTORIA A VOVCHIK
Credential	:	DPM
Telephone Number	:	201-947-1758

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	08/22/2020

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