Provider Demographics
NPI:1225151509
Name:LYNDHURST PODIATRY, P.C.
Entity Type:Organization
Organization Name:LYNDHURST PODIATRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRIGANTI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-939-5877
Mailing Address - Street 1:737 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-3215
Mailing Address - Country:US
Mailing Address - Phone:201-939-5877
Mailing Address - Fax:201-939-5115
Practice Address - Street 1:737 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-3215
Practice Address - Country:US
Practice Address - Phone:201-939-5877
Practice Address - Fax:201-939-5115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD2324213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7027401Medicaid
NJ1206380001Medicare NSC
NJ886578Medicare PIN
NJU62063Medicare UPIN