Provider Demographics
NPI:1518913631
Name:ADVANCED FOOT & ANKLE CENTER OF WILLIAMSTOWN, INC
Entity Type:Organization
Organization Name:ADVANCED FOOT & ANKLE CENTER OF WILLIAMSTOWN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-629-7518
Mailing Address - Street 1:1035 NORTH BLACK HORSE PIKE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-1043
Mailing Address - Country:US
Mailing Address - Phone:856-629-7518
Mailing Address - Fax:856-629-1838
Practice Address - Street 1:1035 NORTH BLACK HORSE PIKE
Practice Address - Street 2:UNIT 1
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-1043
Practice Address - Country:US
Practice Address - Phone:856-629-7518
Practice Address - Fax:856-629-1838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00241700213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8407606Medicaid
NJ8407606Medicaid
NJ852805Medicare ID - Type Unspecified
NJ4480790001Medicare NSC