Provider Demographics
NPI:1104864610
Name:OCEAN FOOT AND ANKLE, PC
Entity Type:Organization
Organization Name:OCEAN FOOT AND ANKLE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANNAKAROS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-294-2666
Mailing Address - Street 1:1 LEIFRIED LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:LITTLE EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-2000
Mailing Address - Country:US
Mailing Address - Phone:609-294-2666
Mailing Address - Fax:609-294-0606
Practice Address - Street 1:1 LEIFRIED LN
Practice Address - Street 2:SUITE B
Practice Address - City:LITTLE EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08087-2000
Practice Address - Country:US
Practice Address - Phone:609-294-2666
Practice Address - Fax:609-294-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD 002520213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8138702Medicaid
NJ073949Medicare ID - Type UnspecifiedMEDICARE #
NJU75333Medicare UPIN
NJ4966800001Medicare NSC