Provider Demographics
NPI:1437217676
Name:MILLBURN PODIATRY GROUP, PC
Entity Type:Organization
Organization Name:MILLBURN PODIATRY GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRIGNO-TADDEO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-376-0700
Mailing Address - Street 1:120 MILLBURN AVE
Mailing Address - Street 2:102
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1942
Mailing Address - Country:US
Mailing Address - Phone:973-376-0700
Mailing Address - Fax:973-376-5401
Practice Address - Street 1:120 MILLBURN AVE
Practice Address - Street 2:102
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1942
Practice Address - Country:US
Practice Address - Phone:973-376-0700
Practice Address - Fax:973-376-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ024737Medicare PIN
NJ4682080001Medicare NSC