Provider Demographics
NPI:1306001466
Name:FOOT & ANKLE ASSOCIATES OF WYCKOFF
Entity Type:Organization
Organization Name:FOOT & ANKLE ASSOCIATES OF WYCKOFF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:NIEUWENHUIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-891-4930
Mailing Address - Street 1:350 FRANKLIN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1909
Mailing Address - Country:US
Mailing Address - Phone:201-891-4930
Mailing Address - Fax:201-891-4715
Practice Address - Street 1:350 FRANKLIN AVE STE 2
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1909
Practice Address - Country:US
Practice Address - Phone:201-891-4930
Practice Address - Fax:201-891-4715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB02125213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ140103Medicare PIN