Provider Demographics
NPI:1497861959
Name:FAMILY FOOTCARE SPECIALIST, INC.
Entity Type:Organization
Organization Name:FAMILY FOOTCARE SPECIALIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MORRIS
Authorized Official - Last Name:SOOY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-678-6678
Mailing Address - Street 1:264 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-2724
Mailing Address - Country:US
Mailing Address - Phone:856-678-6678
Mailing Address - Fax:856-678-4050
Practice Address - Street 1:264 S BROADWAY
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-2724
Practice Address - Country:US
Practice Address - Phone:856-678-6678
Practice Address - Fax:856-678-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8188904Medicaid
NJ8188904Medicaid
NJ0000036115Medicare Oscar/Certification