1013021070 NPI number — FOOT HEALTH CENTERS, P.A.

Table of content: (NPI 1013021070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013021070 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:
1013021070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2007
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:
25 JACKSON RD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08055-9220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-654-1717
Provider Business Practice Location Address Fax Number:
856-795-5994
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COTTRILL
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: 3255708 . This is a "AETNA" 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".
  • 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 ( NH ) . This identifiers is of the category "OTHER".




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