Provider Demographics
NPI:1144408105
Name:GREAT FALLS FOOT & ANKLE CENTER, P.A.
Entity Type:Organization
Organization Name:GREAT FALLS FOOT & ANKLE CENTER, P.A.
Other - Org Name:GREAT FALLS FOOT & ANKLE CENTER, P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:STABILE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-881-1115
Mailing Address - Street 1:21 MILL ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-1886
Mailing Address - Country:US
Mailing Address - Phone:973-881-1115
Mailing Address - Fax:973-881-8686
Practice Address - Street 1:21 MILL ST STE 3
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-1886
Practice Address - Country:US
Practice Address - Phone:973-881-1115
Practice Address - Fax:973-881-8686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00236400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7006501Medicaid
NJ4387630001Medicare NSC
NJU62497Medicare UPIN
NJ886930Medicare PIN