Provider Demographics
NPI:1083897078
Name:OCEAN CITY FOOT & ANKLE P A
Entity Type:Organization
Organization Name:OCEAN CITY FOOT & ANKLE P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMROK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-208-6237
Mailing Address - Street 1:11200 RACETRACK RD STE A104
Mailing Address - Street 2:
Mailing Address - City:OCEAN PINES
Mailing Address - State:MD
Mailing Address - Zip Code:21811-3809
Mailing Address - Country:US
Mailing Address - Phone:410-208-6237
Mailing Address - Fax:410-208-0754
Practice Address - Street 1:11200 RACETRACK RD STE A104
Practice Address - Street 2:
Practice Address - City:OCEAN PINES
Practice Address - State:MD
Practice Address - Zip Code:21811-3809
Practice Address - Country:US
Practice Address - Phone:410-208-6237
Practice Address - Fax:410-208-0754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01303213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1649284381OtherNPI
MD4325810001OtherNHIC, CORP
MD021602000Medicaid
MD8870Medicare PIN
MD4325810001Medicare NSC
MD4325810001OtherNHIC, CORP