Provider Demographics
NPI:1265726830
Name:FOOT & ANKLE SURGICAL ASSOCIATES LLP
Entity type:Organization
Organization Name:FOOT & ANKLE SURGICAL ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GIANNI
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSICH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-728-3334
Mailing Address - Street 1:54 S DEAN STREET
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631
Mailing Address - Country:US
Mailing Address - Phone:718-728-3334
Mailing Address - Fax:718-777-3180
Practice Address - Street 1:54 S DEAN STREET
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:718-728-3334
Practice Address - Fax:718-777-3180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD00304200213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01360874Medicaid