Provider Demographics
NPI:1497023287
Name:EAST BRUNSWICK FOOT CARE, LLC
Entity Type:Organization
Organization Name:EAST BRUNSWICK FOOT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOAG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-679-8700
Mailing Address - Street 1:1405 ROUTE 18
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3719
Mailing Address - Country:US
Mailing Address - Phone:732-679-8700
Mailing Address - Fax:732-640-5733
Practice Address - Street 1:1405 ROUTE 18
Practice Address - Street 2:SUITE 105
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3719
Practice Address - Country:US
Practice Address - Phone:732-679-8700
Practice Address - Fax:732-640-5733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00283600213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty