1104930163 NPI number — FOOT HEALTH CENTERS, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104930163 NPI number — FOOT HEALTH CENTERS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT HEALTH CENTERS, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104930163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
52 BERLIN RD
Provider Second Line Business Mailing Address:
SUITE 5000
Provider Business Mailing Address City Name:
CHERRY HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08034-3574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-795-1003
Provider Business Mailing Address Fax Number:
856-795-5994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 CROSS KEYS RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08009-9263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-768-6693
Provider Business Practice Location Address Fax Number:
856-795-5994
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VASQUEZ
Authorized Official First Name:
JANINE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
856-795-1003

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2808307 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1067235 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0421600000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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