Provider Demographics
NPI:1235629783
Name:BELVIDERE FOOT & ANKLE LLC
Entity Type:Organization
Organization Name:BELVIDERE FOOT & ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYELLEN
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:BRUCATO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-691-0279
Mailing Address - Street 1:550 KINDERKAMACK RD # 121
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1500
Mailing Address - Country:US
Mailing Address - Phone:201-977-1406
Mailing Address - Fax:
Practice Address - Street 1:8 GREENWICH ST
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:NJ
Practice Address - Zip Code:07823-1421
Practice Address - Country:US
Practice Address - Phone:201-977-1406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty