MEDICARE: A CENTER FOR FOOT AND ANKLE SURGERY, P.A.

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

General Provider Information

NPI Number	:	1396926119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A CENTER FOR FOOT AND ANKLE SURGERY, P.A.

Provider Business Mailing Address
First Line	:	7521 BERGENLINE AVE
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5459
Country	:	US
Telephone Number	:	201-854-7585
Fax Number	:

Provider Business Practice Location Address
First Line	:	7521 BERGENLINE AVE
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5459
Country	:	US
Telephone Number	:	201-854-7585
Fax Number	:	201-869-9860

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. DIANE GUADARA
Credential	:
Telephone Number	:	201-854-7585

Provider Enumeration Date	:	11/20/2007
Last Update Date	:	08/26/2008

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