Dr Dina Ibrahim Foot & Ankle Surgery LLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

Legal business name

DR DINA IBRAHIM FOOT & ANKLE SURGERY LLC

Practice address

7600 River Rd
North Bergen, NJ 07047-6217

Phone

(973) 870-0777

NPI assigned

Jul 7, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Derek Mercer

Title

Credentialing Executive

Phone

(718) 841-7318

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618272000000",
    "number": "1619595659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 HUMPHREY AVE",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "070027311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7600 RIVER RD",
            "city": "NORTH BERGEN",
            "state": "NJ",
            "postal_code": "070476217",
            "telephone_number": "973-870-0777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR DINA IBRAHIM FOOT & ANKLE SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-07",
        "last_updated": "2021-04-13",
        "certification_date": "2021-04-13",
        "status": "A",
        "authorized_official_last_name": "MERCER",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "CREDENTIALING EXECUTIVE",
        "authorized_official_telephone_number": "718-841-7318"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Foot & Ankle Surgery Podiatrist in North Bergen, NJ
• Providers in North Bergen, NJ by specialty
• Foot & Ankle Surgery Podiatrist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.