Provider Demographics
NPI:1558564419
Name:JCE FOOT AND ANKLE SPECIALTIES
Entity Type:Organization
Organization Name:JCE FOOT AND ANKLE SPECIALTIES
Other - Org Name:JCE FOOT AND ANKLE SPECIALTIES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:908-352-1400
Mailing Address - Street 1:PO BOX 493
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07207-0493
Mailing Address - Country:US
Mailing Address - Phone:908-352-1400
Mailing Address - Fax:908-352-7900
Practice Address - Street 1:430 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-3609
Practice Address - Country:US
Practice Address - Phone:908-352-1400
Practice Address - Fax:908-352-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD002838213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0084328Medicaid
095356Medicare ID - Type Unspecified
NJ5540390001Medicare NSC