Provider Demographics
NPI:1003455544
Name:GOFOOTCARE, LLC
Entity Type:Organization
Organization Name:GOFOOTCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:VENANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOUSSAINT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-771-3338
Mailing Address - Street 1:20 RUTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-2129
Mailing Address - Country:US
Mailing Address - Phone:201-771-3338
Mailing Address - Fax:855-406-5493
Practice Address - Street 1:550 SUMMIT AVE BSMT
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2707
Practice Address - Country:US
Practice Address - Phone:201-771-3338
Practice Address - Fax:855-406-5493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0663212Medicaid