Provider Demographics
NPI:1114912243
Name:FAMILY FOOT & ANKLE SPECIALISTS
Entity Type:Organization
Organization Name:FAMILY FOOT & ANKLE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:WISHNIE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-968-3833
Mailing Address - Street 1:12 WILLS WAY
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-3770
Mailing Address - Country:US
Mailing Address - Phone:732-968-3833
Mailing Address - Fax:732-968-8821
Practice Address - Street 1:12 WILLS WAY
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3770
Practice Address - Country:US
Practice Address - Phone:732-968-3833
Practice Address - Fax:732-968-8821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00182600213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4746280001Medicare NSC
NJ066855Medicare PIN