Provider Demographics
NPI:1447440292
Name:AKHTAR, AFFAN (DPM)
Entity type:Individual
Prefix:DR
First Name:AFFAN
Middle Name:
Last Name:AKHTAR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 HAMBURG TPKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5043
Mailing Address - Country:US
Mailing Address - Phone:973-692-1111
Mailing Address - Fax:973-692-1234
Practice Address - Street 1:1211 HAMBURG TPKE
Practice Address - Street 2:SUITE 100
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5043
Practice Address - Country:US
Practice Address - Phone:973-692-1111
Practice Address - Fax:973-692-1234
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00293500213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0609660001Medicare NSC
NJ083885Medicare PIN