Provider Demographics
NPI:1679284285
Name:INTEGRATED FOOT AND ANKLE SPECIALISTS OF NJ LLC
Entity type:Organization
Organization Name:INTEGRATED FOOT AND ANKLE SPECIALISTS OF NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:LEONARDA
Authorized Official - Last Name:CIACCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-993-8666
Mailing Address - Street 1:523 ROUTE 73N
Mailing Address - Street 2:SUITE 117A
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:484-535-3285
Mailing Address - Fax:484-535-5446
Practice Address - Street 1:523 ROUTE 73N
Practice Address - Street 2:SUITE 117A
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:484-535-3285
Practice Address - Fax:484-535-5446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty