Provider Demographics
NPI:1215041215
Name:CUMBERLAND FOOT AND ANKLE CENTER LLC
Entity Type:Organization
Organization Name:CUMBERLAND FOOT AND ANKLE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LANING
Authorized Official - Last Name:JESPERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-293-1880
Mailing Address - Street 1:10 E MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-4293
Mailing Address - Country:US
Mailing Address - Phone:856-293-1880
Mailing Address - Fax:856-293-1889
Practice Address - Street 1:10 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-4293
Practice Address - Country:US
Practice Address - Phone:856-293-1880
Practice Address - Fax:856-293-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00256400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
002003517002OtherUNITED HEALTHCARE
2K1658OtherHEALTHNET
NJ2341851000OtherAMERIHEALTH
NJ7040196OtherAETNA
NJ8270902Medicaid
1165751OtherHORIZON NJ HEALTH
30634OtherLOCAL 825
=========OtherGREAT WEST
2K1658OtherHEALTHNET
NJ7040196OtherAETNA
30634OtherLOCAL 825
=========OtherHEALTH CARE PAYORS
NJ8270902Medicaid
=========OtherALTANTICARE
=========OtherMAGNACARE
NJ7040196OtherAETNA
NJ037385Medicare ID - Type Unspecified
=========OtherGREAT WEST
=========OtherALTANTICARE