Provider Demographics
NPI:1295867463
Name:DANA WEBB
Entity Type:Organization
Organization Name:DANA WEBB
Other - Org Name:BRIDGEWATER PODIATRY CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:908-704-8778
Mailing Address - Street 1:720 ROUTE 202-206 NORTH
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807
Mailing Address - Country:US
Mailing Address - Phone:908-704-8778
Mailing Address - Fax:908-704-8172
Practice Address - Street 1:720 ROUTE 202 206 NORTH
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807
Practice Address - Country:US
Practice Address - Phone:908-704-8778
Practice Address - Fax:908-704-8172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01980213ES0131X
NJMD02538213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8405603Medicaid
NJ0980130001Medicare NSC
NJU75028Medicare UPIN
NJT51420Medicare UPIN
117964Medicare PIN