Provider Demographics
NPI:1053479527
Name:ROXBURY FOOT AND ANKLE CENTER, PA
Entity type:Organization
Organization Name:ROXBURY FOOT AND ANKLE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:PIZZANO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-927-2525
Mailing Address - Street 1:274 ROUTE 10 W STE 2
Mailing Address - Street 2:
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1387
Mailing Address - Country:US
Mailing Address - Phone:973-927-2525
Mailing Address - Fax:973-927-3249
Practice Address - Street 1:274 ROUTE 10 W STE 405
Practice Address - Street 2:
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1386
Practice Address - Country:US
Practice Address - Phone:973-927-2525
Practice Address - Fax:973-927-3249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00186600213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001393891OtherHIGHMARK BLUE SHIELD ID
NJ4526420001Medicare NSC
PA001393891OtherHIGHMARK BLUE SHIELD ID