Provider Demographics
NPI:1518110675
Name:FORT LEE PODIATRY GROUP LLC
Entity Type:Organization
Organization Name:FORT LEE PODIATRY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CALIHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-224-5790
Mailing Address - Street 1:1625 ANDERSON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2748
Mailing Address - Country:US
Mailing Address - Phone:201-224-5790
Mailing Address - Fax:201-224-5793
Practice Address - Street 1:1625 ANDERSON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2748
Practice Address - Country:US
Practice Address - Phone:201-224-5790
Practice Address - Fax:201-224-5793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-02
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00093300213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MD00093300OtherLICENSE
NJ25MD00093300OtherLICENSE
NJ175779ZCGNMedicare PIN