1508928979 NPI number — ASSOCIATES IN FOOT AND ANKLE

Table of content: (NPI 1508928979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508928979 NPI number — ASSOCIATES IN FOOT AND ANKLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATES IN FOOT AND ANKLE
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:
1508928979
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2159 ROUTE 88 E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08724-3232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-899-0015
Provider Business Mailing Address Fax Number:
732-899-0061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2159 ROUTE 88 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08724-3232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-899-3366
Provider Business Practice Location Address Fax Number:
732-899-1722
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LARSON
Authorized Official First Name:
JASON
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
732-899-0015

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0068080 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: DB9553 . This is a "RR MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com