Provider Demographics
NPI:1487704417
Name:FOOT AND ANKLE CENTER OF NEW JERSEY LLC
Entity type:Organization
Organization Name:FOOT AND ANKLE CENTER OF NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-755-5545
Mailing Address - Street 1:1024 PARK AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3026
Mailing Address - Country:US
Mailing Address - Phone:908-755-5545
Mailing Address - Fax:908-755-6065
Practice Address - Street 1:1024 PARK AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3026
Practice Address - Country:US
Practice Address - Phone:908-755-5545
Practice Address - Fax:908-755-6065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00274700213EP1101X
NJ25MD00274800213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ086683Medicare ID - Type UnspecifiedGROUP ID#