Provider Demographics
NPI:1497856074
Name:FAMILY FOOTCARE CENTER OF MONTCLAIR
Entity Type:Organization
Organization Name:FAMILY FOOTCARE CENTER OF MONTCLAIR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMI
Authorized Official - Middle Name:M
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-746-3500
Mailing Address - Street 1:313 ORANGE RD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4451
Mailing Address - Country:US
Mailing Address - Phone:973-746-3500
Mailing Address - Fax:973-746-2929
Practice Address - Street 1:313 ORANGE RD
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4451
Practice Address - Country:US
Practice Address - Phone:973-746-3500
Practice Address - Fax:973-746-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003997-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty