1740435924 NPI number — RAMOS FOOT AND ANKLE CENTER LLC

Table of content: (NPI 1740435924)

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".




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