Provider Demographics
NPI:1376007898
Name:PEDI-CARE CORP.
Entity Type:Organization
Organization Name:PEDI-CARE CORP.
Other - Org Name:PEDI-CARE CORP.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER RELATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DESPINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOUKARAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-415-2318
Mailing Address - Street 1:1352 RIVER AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5646
Mailing Address - Country:US
Mailing Address - Phone:732-415-2318
Mailing Address - Fax:732-584-2786
Practice Address - Street 1:1086 TEANECK RD STE 3A
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4857
Practice Address - Country:US
Practice Address - Phone:201-666-6647
Practice Address - Fax:201-676-8828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-29
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies