Provider Demographics
NPI:1003024019
Name:FOOT CARE OF JERSEY CORPORATION
Entity Type:Organization
Organization Name:FOOT CARE OF JERSEY CORPORATION
Other - Org Name:PATRICK CAIN
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-689-7091
Mailing Address - Street 1:669 BROADWAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1947
Mailing Address - Country:US
Mailing Address - Phone:973-689-7091
Mailing Address - Fax:973-689-7561
Practice Address - Street 1:669 BROADWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1947
Practice Address - Country:US
Practice Address - Phone:973-689-7091
Practice Address - Fax:973-689-7561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00284800261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0121185Medicaid
NJ0121185Medicaid
111188Medicare PIN