Organization Name: | COMPLETE FOOT AND ANKLE - MALO |
NPI Number: | 1033556626 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JACOB REINKRAUT (OWNER) |
Mailing Address: | 201 Route 17 11th Floor Rutherford |
State: | NJ US |
Postal Code: | 070702574 |
Phone Number: | 2014452288 |
Fax Number: | |
NPI Enumeration Date: | 05/23/2013 |
NPI Last Update Date: | 05/23/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |