Provider Demographics
NPI:1669586624
Name:FOOT HEALTH CENTER, P.A.
Entity type:Organization
Organization Name:FOOT HEALTH CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-795-1003
Mailing Address - Street 1:52 BERLIN RD
Mailing Address - Street 2:SUITE 5000
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3574
Mailing Address - Country:US
Mailing Address - Phone:856-795-1003
Mailing Address - Fax:856-795-5994
Practice Address - Street 1:905 STATION AVE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1645
Practice Address - Country:US
Practice Address - Phone:856-547-8826
Practice Address - Fax:856-795-5994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0421600000OtherAMERIHEALTH
NJ1067235OtherHORIZON NJ HEALTH
NJ0509880006OtherNATIONAL HERITAGE INS. CO
NJ2808307Medicaid
NJ1067235OtherHORIZON NJ HEALTH
NJ0509880006Medicare NSC