# REBOOT PODIATRY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265203004
- **Authorized official:** ALICIA J KIM DPM (OWNER)
- **Authorized official phone:** (201) 655-3565

## Contact information

- **Practice address:** 72 WILLIS AVE, CRESSKILL, NJ 07626-2432
- **Practice address phone:** (201) 655-3565
- **Mailing address:** 246B LIVINGSTON ST STE 133, NORTHVALE, NJ 07647-1902
- **Mailing address phone:** (201) 655-3565

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 01/10/2024
- **Last updated:** 01/10/2024