Provider Demographics
NPI:1154680940
Name:COMPREHENSIVE FOOT AND ANKLE CENTER
Entity Type:Organization
Organization Name:COMPREHENSIVE FOOT AND ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINH
Authorized Official - Middle Name:
Authorized Official - Last Name:CAO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-344-2500
Mailing Address - Street 1:600 BERLIN CROSS KEYS RD.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-4147
Mailing Address - Country:US
Mailing Address - Phone:609-344-2500
Mailing Address - Fax:609-344-2570
Practice Address - Street 1:2300 ATLANTIC AVE.
Practice Address - Street 2:SUITE 2
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-6619
Practice Address - Country:US
Practice Address - Phone:609-344-2500
Practice Address - Fax:609-344-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-09-24
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
NJ5563420002Medicare NSC