Provider Demographics
NPI:1437162484
Name:NEWPORT FAMILY FOOT CARE
Entity Type:Organization
Organization Name:NEWPORT FAMILY FOOT CARE
Other - Org Name:JORDAN SHEFF DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHEFF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:401-846-8050
Mailing Address - Street 1:392 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-1733
Mailing Address - Country:US
Mailing Address - Phone:401-846-8050
Mailing Address - Fax:401-848-0458
Practice Address - Street 1:392 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-1733
Practice Address - Country:US
Practice Address - Phone:401-846-8050
Practice Address - Fax:401-848-0458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI293213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9007824Medicaid
RI4801940001Medicare NSC
U67123Medicare UPIN