1427246354 NPI number — COMPREHENSIVE FAMILY FOOT CARE, PA.

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 1427246354 NPI number — COMPREHENSIVE FAMILY FOOT CARE, PA.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE FAMILY FOOT CARE, PA.
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:
1427246354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 FRANKLIN TPKE STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAHWAH
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07430-3516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-818-9114
Provider Business Mailing Address Fax Number:
201-934-8223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 FRANKLIN TPKE STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAHWAH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07430-3516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-818-9114
Provider Business Practice Location Address Fax Number:
201-934-8223
Provider Enumeration Date:
10/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GILLESPIE
Authorized Official First Name:
LISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
201-818-9114

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  25MD00180700 , 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)





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