1740435924 NPI number — RAMOS FOOT AND ANKLE CENTER LLC

Table of content: MELISSA MARGARET GOOSMANN MA LPC (NPI 1811417355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740435924 NPI number — RAMOS FOOT AND ANKLE CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAMOS FOOT AND ANKLE CENTER LLC
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:
1740435924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
474 AMBOY AVE
Provider Second Line Business Mailing Address:
2ND FLR
Provider Business Mailing Address City Name:
PERTH AMBOY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08861-3145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-442-6444
Provider Business Mailing Address Fax Number:
732-442-6449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
474 AMBOY AVE
Provider Second Line Business Practice Location Address:
2ND FLR
Provider Business Practice Location Address City Name:
PERTH AMBOY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08861-3145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-442-6444
Provider Business Practice Location Address Fax Number:
732-442-6449
Provider Enumeration Date:
12/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RAMOS
Authorized Official First Name:
FAUSTO
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
732-442-6444

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  25MD00287000 , 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: DP3958 . This is a "RAIL ROAD MEDICARE GROUP PTAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com