Provider Demographics
NPI:1437471497
Name:COUNTY PODIATRY ASSOC PA
Entity Type:Organization
Organization Name:COUNTY PODIATRY ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WISLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-585-4433
Mailing Address - Street 1:1773 KUSER RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3703
Mailing Address - Country:US
Mailing Address - Phone:609-585-4433
Mailing Address - Fax:609-585-8288
Practice Address - Street 1:1773 KUSER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3703
Practice Address - Country:US
Practice Address - Phone:609-585-4433
Practice Address - Fax:609-585-8288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD000940213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3387500Medicaid
NJ3387500Medicaid
NJ146324Medicare PIN