Provider Demographics
NPI:1033105606
Name:FOOT AND ANKLE CENTRE OF NEW JERSEY P A
Entity Type:Organization
Organization Name:FOOT AND ANKLE CENTRE OF NEW JERSEY P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:HABER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-599-5911
Mailing Address - Street 1:30 W CENTURY RD
Mailing Address - Street 2:STE 240
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1433
Mailing Address - Country:US
Mailing Address - Phone:201-599-5911
Mailing Address - Fax:201-599-5960
Practice Address - Street 1:30 W CENTURY RD
Practice Address - Street 2:STE 240
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1433
Practice Address - Country:US
Practice Address - Phone:201-599-5911
Practice Address - Fax:201-599-5960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD001556213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4536700001Medicare NSC
155349Medicare ID - Type Unspecified