Organization Active NPI

Ankle & Foot Surgery, PA

  • Podiatrist
  • Denville, NJ
National Provider Identifier
1972761435
Registry record updated Nov 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
25MD00187700 Issued in NJ
Legal business name
ANKLE & FOOT SURGERY, PA
Practice address
16 Pocono Rd
Suite 209
Denville, NJ 07834-2901
Phone
(973) 331-7900
Fax
(973) 331-7999
NPI assigned
May 30, 2008
Last updated
Nov 4, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2014

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

Authorized official

Name
Dr. Dean Peter Licopantis, DPMNPI 1760478010
Title
Podiatrist
Phone
(973) 331-7900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X 25MD00187700 NJ Primary

Addresses

Primary practice location

16 Pocono Rd
Suite 209
Denville, NJ 07834-2901

Mailing address

16 Pocono Rd
Suite 209
Denville, NJ 07834-2901
Phone (973) 331-7900

Other identifiers 1

IdentifierTypeStateIssuer
0943908MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080721000026 NJ Part B Supplier - Clinic/Group Practice 3577636877 Receives reassigned benefits from 1 practitioner
Practice locations: Denville, NJ

National Provider Directory

National Provider Directory

Locations

16 Pocono Rd
Ste 209
Denville, NJ 07834
Phone (201) 366-6600

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1212105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415059200000",
    "number": "1972761435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 POCONO RD",
            "address_2": "SUITE 209",
            "city": "DENVILLE",
            "state": "NJ",
            "postal_code": "078342901",
            "telephone_number": "973-331-7900",
            "fax_number": "973-331-7999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 POCONO RD",
            "address_2": "SUITE 209",
            "city": "DENVILLE",
            "state": "NJ",
            "postal_code": "078342901",
            "telephone_number": "973-331-7900",
            "fax_number": "973-331-7999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANKLE & FOOT SURGERY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-30",
        "last_updated": "2014-11-04",
        "status": "A",
        "authorized_official_last_name": "LICOPANTIS",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "PETER",
        "authorized_official_title_or_position": "PODIATRIST",
        "authorized_official_telephone_number": "973-331-7900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "NJ",
            "license": "25MD00187700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0943908",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Denville, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.