Jersey Foot and Ankle Clinic, LLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

25MD00296100 Issued in NJ

Legal business name

JERSEY FOOT AND ANKLE CLINIC, LLC

Practice address

152 Market St
Suite 314
Paterson, NJ 07505-1724

Phone

(973) 278-4200

NPI assigned

Mar 28, 2011

Last updated

Jan 19, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Henrietta I Obidigbo, DPMNPI 1861669749

Title

Owner

Phone

(973) 216-9071

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ2 enrollments

Enrollment records 2

Locations

Practitioners 1

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.

• Henrietta Ifeoma Obidigbo, DPM

  • Specialist
  • Plainfield, NJ
  • NPI 1861669749
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1301270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326931200000",
    "number": "1982993119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "152 MARKET ST",
            "address_2": "SUITE 314",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075051724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 MARKET ST",
            "address_2": "SUITE 314",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075051724",
            "telephone_number": "973-278-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERSEY FOOT AND ANKLE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-28",
        "last_updated": "2012-01-19",
        "status": "A",
        "authorized_official_last_name": "OBIDIGBO",
        "authorized_official_first_name": "HENRIETTA",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-216-9071",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NJ",
            "license": "25MD00296100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Foot & Ankle Surgery Podiatrist in Paterson, NJ
• Providers in Paterson, 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 Jan 19, 2012; 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.