Provider Demographics
NPI:1407929631
Name:RIVERVIEW FOOT & ANKLE ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:RIVERVIEW FOOT & ANKLE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEITCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-747-2111
Mailing Address - Street 1:130 MAPLE AVENUE
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:732-747-2111
Mailing Address - Fax:732-530-1348
Practice Address - Street 1:130 MAPLE AVENUE
Practice Address - Street 2:SUITE 3B
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701
Practice Address - Country:US
Practice Address - Phone:732-747-2111
Practice Address - Fax:732-530-1348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00103800213E00000X
NJ25MD00256900213E00000X
NJ25MD00220900213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3325407Medicaid
T77787Medicare UPIN
NJ3325407Medicaid
NJ0675470001Medicare NSC
U44850Medicare UPIN
192592Medicare ID - Type Unspecified