Provider Demographics
NPI:1235647231
Name:PERSONAL CARE PODIATRY LLC
Entity Type:Organization
Organization Name:PERSONAL CARE PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:908-380-4959
Mailing Address - Street 1:118 NORTH AVE, WEST
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-3132
Mailing Address - Country:US
Mailing Address - Phone:908-795-1979
Mailing Address - Fax:908-272-1323
Practice Address - Street 1:118 NORTH AVE, WEST
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-3132
Practice Address - Country:US
Practice Address - Phone:908-795-1979
Practice Address - Fax:908-272-1323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty