Provider Demographics
NPI:1013031053
Name:HAPPY FEET PODIATRY LLC
Entity Type:Organization
Organization Name:HAPPY FEET PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARNELL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-337-2893
Mailing Address - Street 1:310 CENTRAL AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2838
Mailing Address - Country:US
Mailing Address - Phone:973-337-2893
Mailing Address - Fax:201-228-1689
Practice Address - Street 1:310 CENTRAL AVE STE 303
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2838
Practice Address - Country:US
Practice Address - Phone:973-337-2893
Practice Address - Fax:201-228-1689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00289000213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0919349Medicaid
112892Medicare PIN