1447231139 NPI number — FOOTPRINTS ORTHOTIC SERVICES, INC.

Table of content: (NPI 1447231139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447231139 NPI number — FOOTPRINTS ORTHOTIC SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOTPRINTS ORTHOTIC SERVICES, INC.
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:
1447231139
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42 BAYVIEW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTPORT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11941-1103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-257-7892
Provider Business Mailing Address Fax Number:
201-796-7133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
261 JAMES ST
Provider Second Line Business Practice Location Address:
SUITE 3C
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07960-6392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-257-7892
Provider Business Practice Location Address Fax Number:
201-796-7133
Provider Enumeration Date:
11/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CAPRARI
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-257-7892

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  45OR00002500 , 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: 1K7303 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5355109 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 577997 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 86306 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1022289 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: A3099191 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 010003370 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01080088 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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