Provider Demographics
NPI:1093232530
Name:FOOTPRINTS EASTERN PA LLC
Entity Type:Organization
Organization Name:FOOTPRINTS EASTERN PA LLC
Other - Org Name:FOOTPRINTS TO RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:YESHAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKOVITS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-903-1964
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-0090
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:992 OLD EAGLE SCHOOL RD STE 904
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1803
Practice Address - Country:US
Practice Address - Phone:877-293-7150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder