Provider Demographics
NPI:1003858598
Name:ASSOCIATED FOOT & ANKLE SPECIALISTS, LLC
Entity Type:Organization
Organization Name:ASSOCIATED FOOT & ANKLE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:HERSTIK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-816-8778
Mailing Address - Street 1:370 GRAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4154
Mailing Address - Country:US
Mailing Address - Phone:201-816-8778
Mailing Address - Fax:201-816-9009
Practice Address - Street 1:370 GRAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4154
Practice Address - Country:US
Practice Address - Phone:201-816-8778
Practice Address - Fax:201-816-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD2186213ES0103X
NYN004973213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01716361Medicaid
NJ7994702Medicaid
NJ7994702Medicaid
NY01716361Medicaid
NJ029918Medicare PIN
NYP55761Medicare PIN