Provider Demographics
NPI:1124229588
Name:CLIFTON FOOT CENTER
Entity Type:Organization
Organization Name:CLIFTON FOOT CENTER
Other - Org Name:CLIFTON FOOT AND ANKLE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-472-4700
Mailing Address - Street 1:925 CLIFTON AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2724
Mailing Address - Country:US
Mailing Address - Phone:973-472-4700
Mailing Address - Fax:973-470-0216
Practice Address - Street 1:925 CLIFTON AVE
Practice Address - Street 2:STE107
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2724
Practice Address - Country:US
Practice Address - Phone:973-472-4700
Practice Address - Fax:973-470-0216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00175400213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID
NJ=========OtherTAX ID
NJ574130Medicare ID - Type UnspecifiedPROVIDER NUMBER