Provider Demographics
NPI:1205862471
Name:CEDAR GROVE FOOT AND ANKLE ASSOCIATES LLC
Entity Type:Organization
Organization Name:CEDAR GROVE FOOT AND ANKLE ASSOCIATES LLC
Other - Org Name:CEDAR GROVE FOOT & ANKLE ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:ZINA
Authorized Official - Middle Name:B
Authorized Official - Last Name:CAPPIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-857-1184
Mailing Address - Street 1:886 POMPTON AVE
Mailing Address - Street 2:SUITE A-1; CANFIELD OFFICE PARK
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1257
Mailing Address - Country:US
Mailing Address - Phone:973-857-1184
Mailing Address - Fax:973-857-3114
Practice Address - Street 1:886 POMPTON AVE
Practice Address - Street 2:SUITE A-1; CANFIELD OFFICE PARK
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1257
Practice Address - Country:US
Practice Address - Phone:973-857-1184
Practice Address - Fax:973-857-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4341540001Medicare NSC
NJ049886Medicare PIN