Provider Demographics
NPI:1073726972
Name:EDISON FOOT AND ANKLE CARE PC
Entity Type:Organization
Organization Name:EDISON FOOT AND ANKLE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILOU
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-318-6780
Mailing Address - Street 1:102 JAMES ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820
Mailing Address - Country:US
Mailing Address - Phone:732-494-5601
Mailing Address - Fax:732-321-6530
Practice Address - Street 1:102 JAMES ST
Practice Address - Street 2:SUITE 301
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:732-494-5601
Practice Address - Fax:732-321-6530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1003040001Medicare NSC
NJ110594Medicare UPIN