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NPI Code Detail

MEDICARE: INTEGRATED FOOT AND ANKLE SPECIALISTS OF NJ LLC

MEDICARE: INTEGRATED FOOT AND ANKLE SPECIALISTS OF NJ 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
1332B00000XDurable Medical Equipment & Medical Supplies
2261QP1100XPodiatric Clinic/Center

General Provider Information

NPI Number : 1154145654
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTEGRATED FOOT AND ANKLE SPECIALISTS OF NJ LLC
Provider Business Mailing Address
First Line : 50 S 16TH ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19102-2516
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 222 NEW RD STE 205
Second Line :
City : LINWOOD
State : NJ
Zip : 08221-1281
Country : US
Telephone Number : 609-653-2066
Fax Number :
Authorized Official
Title or Position : CHIEF OPERATING OFFICER
Name : TERESA LEONARDA CIACCIO
Credential :
Telephone Number : 516-993-8666
Provider Enumeration Date : 11/12/2024
Last Update Date : 11/12/2024

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Directions to “INTEGRATED FOOT AND ANKLE SPECIALISTS OF NJ LLC ” Practice Location

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