Provider Demographics
NPI:1508928979
Name:ASSOCIATES IN FOOT AND ANKLE
Entity Type:Organization
Organization Name:ASSOCIATES IN FOOT AND ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-899-0015
Mailing Address - Street 1:2159 ROUTE 88 E
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3232
Mailing Address - Country:US
Mailing Address - Phone:732-899-0015
Mailing Address - Fax:732-899-0061
Practice Address - Street 1:2159 ROUTE 88 E
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3232
Practice Address - Country:US
Practice Address - Phone:732-899-3366
Practice Address - Fax:732-899-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0068080Medicaid
NJDB9553OtherRR MEDICARE
NJ0068080Medicaid
NJ091107Medicare PIN