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NPI Code Detail

MEDICARE: BROADWAY FOOT AND ANKLE CTR PA

MEDICARE: BROADWAY FOOT AND ANKLE CTR PA
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
1213ES0103XFoot & Ankle Surgery Podiatrist

General Provider Information

NPI Number : 1437106689
Entity Type Code : Organization
Provider Name (Legal Business Name) : BROADWAY FOOT AND ANKLE CTR PA
Provider Business Mailing Address
First Line : 67 BROADWAY
Second Line :
City : ELMWOOD PARK
State : NJ
Zip : 07407-1836
Country : US
Telephone Number : 201-794-3223
Fax Number : 201-794-8411
Provider Business Practice Location Address
First Line : 67 BROADWAY
Second Line :
City : ELMWOOD PARK
State : NJ
Zip : 07407-1836
Country : US
Telephone Number : 201-794-3223
Fax Number : 201-794-8411
Authorized Official
Title or Position : PRESIDENT
Name : DR. PASKO L GAZIVODA
Credential : DPM
Telephone Number : 201-794-3223
Provider Enumeration Date : 05/30/2006
Last Update Date : 08/22/2020

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Directions to “BROADWAY FOOT AND ANKLE CTR PA ” Practice Location

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