Provider Demographics
NPI:1003024563
Name:FOOT CARE OF LIVINGSTON PC
Entity Type:Organization
Organization Name:FOOT CARE OF LIVINGSTON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPILKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-992-9214
Mailing Address - Street 1:349 EAST NORTHFIELD ROAD
Mailing Address - Street 2:LOWER LEVEL 6
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4671
Mailing Address - Country:US
Mailing Address - Phone:973-992-9214
Mailing Address - Fax:973-992-4625
Practice Address - Street 1:349 E NORTHFIELD RD
Practice Address - Street 2:LOWER LEVEL 6
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4802
Practice Address - Country:US
Practice Address - Phone:973-992-9214
Practice Address - Fax:973-992-4625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01408213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5906550001Medicare NSC
NJT45023Medicare UPIN
NJ444697Medicare ID - Type Unspecified