Provider Demographics
NPI:1386855575
Name:GARDEN STATE FOOT & ANKLE GROUP, LLC
Entity Type:Organization
Organization Name:GARDEN STATE FOOT & ANKLE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANKUR
Authorized Official - Middle Name:
Authorized Official - Last Name:DHARIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-557-9900
Mailing Address - Street 1:20 HOSPITAL DR
Mailing Address - Street 2:SUITE 9
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6434
Mailing Address - Country:US
Mailing Address - Phone:732-557-9900
Mailing Address - Fax:732-557-9909
Practice Address - Street 1:20 HOSPITAL DR
Practice Address - Street 2:SUITE 9
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6434
Practice Address - Country:US
Practice Address - Phone:732-557-9900
Practice Address - Fax:732-557-9909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-27
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5987480001Medicare NSC
NJ113994Medicare PIN