Provider Demographics
NPI:1467757591
Name:PEDI-CARE CORP.
Entity Type:Organization
Organization Name:PEDI-CARE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DESPINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOUKARAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-415-2318
Mailing Address - Street 1:1352 RIVER AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5646
Mailing Address - Country:US
Mailing Address - Phone:732-415-2318
Mailing Address - Fax:732-584-2786
Practice Address - Street 1:1352 RIVER AVE STE 4
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5646
Practice Address - Country:US
Practice Address - Phone:732-415-2318
Practice Address - Fax:732-584-2786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NJ04003305999335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies