Provider Demographics
NPI:1447231139
Name:FOOTPRINTS ORTHOTIC SERVICES, INC.
Entity Type:Organization
Organization Name:FOOTPRINTS ORTHOTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAPRARI
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:800-257-7892
Mailing Address - Street 1:42 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11941-1103
Mailing Address - Country:US
Mailing Address - Phone:800-257-7892
Mailing Address - Fax:201-796-7133
Practice Address - Street 1:261 JAMES ST
Practice Address - Street 2:SUITE 3C
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6392
Practice Address - Country:US
Practice Address - Phone:800-257-7892
Practice Address - Fax:201-796-7133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45OR00002500335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1K7303OtherHEALTHNET
NJ5355109Medicaid
NJ577997OtherAETNA
NJ86306OtherAMERIGROUP
NJ1022289OtherHORIZON NJ HEALTH
NJA3099191OtherOXFORD
NJ010003370OtherAMERICHOICE
NY01080088Medicaid
NJ5355109Medicaid
NJ86306OtherAMERIGROUP