Provider Demographics
NPI:1114974698
Name:COMPREHENSIVE FOOT & ANKLE CENTER, LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE FOOT & ANKLE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MINH
Authorized Official - Middle Name:P
Authorized Official - Last Name:CAO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-875-9553
Mailing Address - Street 1:571 BERLIN CROSS KEYS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-9550
Mailing Address - Country:US
Mailing Address - Phone:856-875-9553
Mailing Address - Fax:856-875-9443
Practice Address - Street 1:571 BERLIN CROSS KEYS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-9550
Practice Address - Country:US
Practice Address - Phone:856-875-9553
Practice Address - Fax:856-875-9443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00276000213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0026247Medicaid
NJ0026247Medicaid
NJ097641Medicare ID - Type UnspecifiedMEDICARE #
NJ5563420001Medicare NSC